Provider Demographics
NPI:1861229486
Name:DAVIS, LINDSAY Q
Entity type:Individual
Prefix:MR
First Name:LINDSAY
Middle Name:Q
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18855 BURNHAM AVE APT 332
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-3656
Mailing Address - Country:US
Mailing Address - Phone:219-608-6299
Mailing Address - Fax:
Practice Address - Street 1:18855 BURNHAM AVE APT 332
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-3656
Practice Address - Country:US
Practice Address - Phone:219-608-6299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILD12053564032172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver