1467948422 NPI number — CRAIG RYAN ADAMSKI CGC

Table of content: CRAIG RYAN ADAMSKI CGC (NPI 1467948422)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467948422 NPI number — CRAIG RYAN ADAMSKI CGC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADAMSKI
Provider First Name:
CRAIG
Provider Middle Name:
RYAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CGC
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:
1467948422
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7801 W LISBON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53222-3939
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-669-8898
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5230 S STATE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANN ARBOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48108-7936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-293-2639
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2018

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: 170300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 15447 . This is a "ABGC" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com