Provider Demographics
NPI:1295712412
Name:DAVAKIS, STEPHEN M (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:DAVAKIS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:4895 OLENTANGY RIVER RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1926
Mailing Address - Country:US
Mailing Address - Phone:614-267-8371
Mailing Address - Fax:614-262-0005
Practice Address - Street 1:4895 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE 250
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1926
Practice Address - Country:US
Practice Address - Phone:614-267-8371
Practice Address - Fax:614-262-0005
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2013-08-13
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Provider Licenses
StateLicense IDTaxonomies
OH35-057108207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0747142Medicaid
OH0747142Medicaid
OHE65480Medicare UPIN