Individual
ELISSA DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4700 MEMORIAL DR STE 350, BELLEVILLE, IL 62226-5373
(618) 212-4414
(618) 235-9020
Mailing address
4700 MEMORIAL DR STE 340, BELLEVILLE, IL 62226-5373
(618) 234-9884
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
036152355
IL
207XS0106X
Orthopaedic Hand Surgery Physician
Primary
036152355
IL
390200000X
Student in an Organized Health Care Education/Training Program
4301117482
MI
Other
Enumeration date
04/01/2014
Last updated
02/26/2021
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