Individual
GENE DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6640 GLORIA ST, ROMULUS, MI 48174-4358
(734) 890-4623
Mailing address
6640 GLORIA ST, ROMULUS, MI 48174-4358
(734) 890-4623
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0165642
—
MI
Enumeration date
07/27/2015
Last updated
07/27/2015
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