Provider Demographics
NPI:1881857688
Name:DAVIS, MICHAEL DURRELL (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DURRELL
Last Name:DAVIS
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Gender:M
Credentials:PHD
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Mailing Address - Street 1:1151 TAYLOR STREET
Mailing Address - Street 2:HERMAN KIEFER COMPLEX ROOM 150-C
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-1732
Mailing Address - Country:US
Mailing Address - Phone:313-876-4222
Mailing Address - Fax:313-876-4221
Practice Address - Street 1:1151 TAYLOR STREET
Practice Address - Street 2:HERMAN KIEFER HEALTH COMPLEX 150-C
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-1732
Practice Address - Country:US
Practice Address - Phone:313-876-4222
Practice Address - Fax:313-876-4221
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician