1033103692 NPI number — JOHN THOMAS ADAMS MD

Table of content: JOHN THOMAS ADAMS MD (NPI 1033103692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033103692 NPI number — JOHN THOMAS ADAMS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADAMS
Provider First Name:
JOHN
Provider Middle Name:
THOMAS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033103692
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43800 GARFIELD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLINTON TWP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48038-1136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-848-0202
Provider Business Mailing Address Fax Number:
586-226-6949

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22201 MOROSS RD
Provider Second Line Business Practice Location Address:
270
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48236-2169
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-343-3481
Provider Business Practice Location Address Fax Number:
313-343-7937
Provider Enumeration Date:
09/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080N0001X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3093489 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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