Individual
DR. MICHAEL KEITH DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
20 MEDICAL VILLAGE DR STE 254, EDGEWOOD, KY 41017-5401
(859) 344-1600
(859) 344-0091
Mailing address
PO BOX 635283, CINCINNATI, OH 45263-5283
(859) 344-1600
(859) 344-0091
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
32327
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020035820
RAILROAD MEDICARE
—
05
—
200078970
—
IN
05
—
201067710
—
IN
05
—
2469136
—
OH
05
—
64323272
—
KY
05
—
7100056850
—
KY
01
—
P00670401
RAILROAD MEDICARE
—
Enumeration date
06/17/2005
Last updated
11/18/2019
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