Davenport, Michael Keith

Davenport, Michael Keith is an individual health care provider with primary practice located at 20 Medical Village Dr Ste 254 , Edgewood KY 41017-5401. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Davenport, Michael Keith can be contacted via phone (859) 344-1600.

Contact Information

Primary practice address
20 Medical Village Dr Ste 254 Edgewood KY 41017-5401
Phone: (859) 344-1600
Fax: (859) 344-0091
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 32327 Kentucky

Profile Details

NPI number 1710982517
LBN Legal business name Davenport, Michael Keith
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 17th, 2005
Last updated Nov 18th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1710982517 NPPES
Ohio MEDICAID 2469136
Ohio MEDICAID 7100056850
Ohio MEDICAID 200078970
Ohio MEDICAID 64323272
Ohio Other 020035820
Ohio MEDICAID 201067710
Ohio Other P00670401

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