Individual
DR. LARRY DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6809 122ND AVE, KENOSHA, WI 53142-7335
(262) 654-8633
(262) 654-5467
Mailing address
9000 W WISCONSIN AVE # MS 958, MILWAUKEE, WI 53226-4874
(414) 266-7615
(414) 266-6238
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
036-104343
IL
208000000X
Pediatrics Physician
Primary
69544-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036104343
—
IL
05
—
1699715888
—
WI
Enumeration date
06/07/2006
Last updated
02/01/2019
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