| Doctor Name: | KEITH DAVIDSON |
| NPI Number: | 1366827982 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | NP-C |
| License Number: | 4704274292 |
| Business Practice Address: | 3532 Main St Deckerville, MI - 484279615 |
| Business Phone Number: | 8103763100 |
| Business Fax Number: | 8103768311 |
| Mailing Address: | Po Box 126, 3532 Main Street DECKERVILLE |
| State: | MI |
| Postal Code: | 484270126 |
| Phone Number: | 8103763100 |
| Fax Number: | 8103768311 |
| NPI Enumeration Date: | 07/24/2015 |
| NPI Last Update Date: | 07/24/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 4704274292 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |