Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 35-084193 | OH |
Y | 111NI0900X | Internist | 35-084193 | OH |
N | 207RA0401X | Internist - Addiction Medicine | 35-084193 | OH |
N | 208000000X | Pediatrician | 35-084193 | OH |
NPI | 1487677233 |
---|---|
Provider Name | Cherrica T Davis |
First Address | Detroit, MI 48278-1389 |
Second Address | Willowick, OH 44095 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 26/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2668206 | (05) | OH |