Individual
ANDREA DAVENPORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
17321 INDIANA ST, DETROIT, MI 48221-2402
(313) 420-9633
Mailing address
17321 INDIANA ST, DETROIT, MI 48221-2402
(313) 420-9633
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
D116067609949
MI
Other
Enumeration date
06/17/2015
Last updated
06/17/2015
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