Individual
MICAH R DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
165 EDWIN C MOSES BLVD, DAYTON, OH 45402
(937) 558-0180
Mailing address
1323 W 3RD ST, DAYTON, OH 45402-6714
(937) 586-9733
(937) 586-9736
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34008628
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2606120
—
OH
01
—
3601331
MEDICARE GROUP NUMBER
OH
Enumeration date
11/14/2005
Last updated
05/19/2015
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