Kirk Wagner Davis

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

1110 S Washington Ave
Park Ridge, IL 60068-4815

Phone

(773) 497-9417

NPI assigned

Jul 2, 2025

Last updated

Jul 2, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1751414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751414400000",
    "number": "1679462543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 S WASHINGTON AVE",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600684815",
            "telephone_number": "773-497-9417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 S WASHINGTON AVE",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600684815",
            "telephone_number": "773-497-9417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "KIRK",
        "middle_name": "WAGNER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-07-02",
        "last_updated": "2025-07-02",
        "certification_date": "2025-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Davis & Engert P.C.
• Christine Davis, DPT
• James Craig Davis, DDS
• John Frederick Davis, D.D.S.
• Julie K Davis, D.D.S.
• William Davison, M.D.
• Dalia Davood, M.D.
• Jeanne T De Lisle, PT
• Katherine De Los Trinos-Ocampo
• April De Mito, APN

• Student in an Organized Health Care Education/Training Program in Park Ridge, IL
• Providers in Park Ridge, IL by specialty
• Student in an Organized Health Care Education/Training Program in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.