Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 01083879A | IN |
N | 208000000X | Pediatrician | 1124446984 | OH |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 01083879A | IN |
NPI | 1124446984 |
---|---|
Provider Name | Dr. Kyle Andrew Davis |
First Address | Indianapolis, IN 46260-1920 |
Second Address | Indianapolis, IN 46260-1920 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2014 |
Last Update Date | 09/09/2021 |