Provider Demographics
NPI:1982856118
Name:DAVIS, VANESSA (MD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 W POLK ST
Mailing Address - Street 2:SUITE 1144
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3723
Mailing Address - Country:US
Mailing Address - Phone:312-864-4172
Mailing Address - Fax:312-864-9582
Practice Address - Street 1:1900 W POLK ST
Practice Address - Street 2:C/O DR DAVID SOGLIN,SUITE 1100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3723
Practice Address - Country:US
Practice Address - Phone:312-864-4506
Practice Address - Fax:312-864-4506
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-107957208000000X
IL0361079572080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics