Provider Demographics
NPI:1871565085
Name:DAVIS, TROY D (D O)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:D
Last Name:DAVIS
Suffix:
Gender:M
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 N CHICAGO ST
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49252-9792
Mailing Address - Country:US
Mailing Address - Phone:517-542-3217
Mailing Address - Fax:
Practice Address - Street 1:413 N CHICAGO ST
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:MI
Practice Address - Zip Code:49252-9792
Practice Address - Country:US
Practice Address - Phone:517-542-3217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013336207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4125694Medicaid
MI0853000095OtherBCBS
MI4125694Medicaid
MIG89914Medicare UPIN