Individual
ELLEN REA DAVIDEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
200 JEFFERSON AVE SE, GRAND RAPIDS, MI 49503-4502
(616) 685-6922
Mailing address
1632 STONE ST, SAGINAW, MI 48602
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4351052998
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/23/2022
Last updated
07/03/2024
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