1518025014 NPI number — KAYE E. DAVIS, MD, SC

Table of content: (NPI 1518025014)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518025014 NPI number — KAYE E. DAVIS, MD, SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KAYE E. DAVIS, MD, SC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518025014
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1448 E 52ND ST
Provider Second Line Business Mailing Address:
# 396
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60615-4122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-939-4896
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19110 DARVIN DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOKENA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-478-8507
Provider Business Practice Location Address Fax Number:
708-478-8507
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
KAYE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
312-939-4896

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 04932277 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: DC5610 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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