Michael F Davidson, MD
Individual provider Active NPI Family Medicine Physician · Lemont, IL
NPI 1114620192 · NPPES record last updated Jun 17, 2026
Key facts
- NPI
- 1114620192
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 036179100 (IL)
- Practice address
- 15505 E 127TH St Ste 100
Lemont, IL 60439-4433 - Phone
- (815) 300-7264
- Fax
- (630) 257-1954
- NPI assigned
- Mar 27, 2023
- Sex
- Male
- Sole proprietor
- No
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2022
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
12252 W Thorn Apple Dr
Homer Glen, IL 60491-6929
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260622002091 | IL | Practitioner - Family Practice | 3779056767 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125082805 | IL | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036179100 | IL | Yes |
Addresses
Primary practice location
15505 E 127TH St Ste 100
Lemont, IL 60439-4433
Mailing address
15505 E 127TH St Ste 100
Lemont, IL 60439-4433
Phone (815) 300-7264
Other providers in Lemont, IL
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- Jacqueline Perry Dauw
- Sydney Marie De Cicco
- Beata Dederowski
- Kimberly Dawn Dennis
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- Rachel S Digiulio
All providers in Lemont, IL · Family Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 17, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.