Provider Demographics
NPI:1720315807
Name:DAVIS-BAUMANN, JILLIAN DIANE (DO)
Entity Type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:DIANE
Last Name:DAVIS-BAUMANN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JILLIAN
Other - Middle Name:DIANE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:38935 ANN ARBOR RD
Mailing Address - Street 2:CREDENTIALING DEPT
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3397
Mailing Address - Country:US
Mailing Address - Phone:734-805-0488
Mailing Address - Fax:866-250-6385
Practice Address - Street 1:15855 NINTEEN MILED ROAD
Practice Address - Street 2:EMERGENCY DEPT
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-3504
Practice Address - Country:US
Practice Address - Phone:586-263-2601
Practice Address - Fax:586-263-2589
Is Sole Proprietor?:No
Enumeration Date:2009-11-10
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101018413207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI12551412OtherCAQH