Doctor Name: | DANIEL DAVIDOVICH |
NPI Number: | 1457615544 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | MED10663 |
Business Practice Address: | 701 Park Ave. South, Medicine Hennepin County Medical Center Minneapolis, MN - 554151829 |
Business Phone Number: | 6128732300 |
Business Fax Number: | 6129044358 |
Mailing Address: | 701 Park Ave. South, Medicine, Hennepin County Medical Center MINNEAPOLIS |
State: | MN |
Postal Code: | 554151829 |
Phone Number: | 6128732300 |
Fax Number: | 6129044358 |
NPI Enumeration Date: | 07/03/2012 |
NPI Last Update Date: | 07/03/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | MED10663 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ZZ |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |