| Davenport Medical Inc | |
|
1023 Mapleton Ave Oak Park IL 60302-1405 | |
| (773) 543-8964 | |
| Not Available |
| Full Name | Davenport Medical Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1023 Mapleton Ave, Oak Park, Illinois |
| Authorized Official Name and Position | Tracey Davenport (PRESIDENT/AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 7735438964 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Davenport Medical Inc 1023 Mapleton Ave Oak Park IL 60302-1405 Ph: (773) 543-8964 | Davenport Medical Inc 1023 Mapleton Ave Oak Park IL 60302-1405 Ph: (773) 543-8964 |
| NPI Number | 1619603065 |
|---|---|
| Provider Enumeration Date | 07/28/2022 |
| Last Update Date | 07/28/2022 |
| Medicare PECOS PAC ID | 0244613628 |
|---|---|
| Medicare Enrollment ID | O20220817003029 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619603065 | NPI | - | NPPES |
| 036114303 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Tracey M Davenport |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114033826 PECOS PAC ID: 5799703245 Enrollment ID: I20051103000670 |
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