Basic Information
| Provider Information | |||||||||
| NPI: | 1205036696 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MICHAEL W ADAMS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ADAMS FAMILY PRACTICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1506 SIOUX DR | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | IL | ||||||||
| PostalCode: | 629595209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6189975270 | ||||||||
| FaxNumber: | 6189975029 | ||||||||
| Practice Location | |||||||||
| Address1: | 1506 SIOUX DR | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | IL | ||||||||
| PostalCode: | 629595209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6189975270 | ||||||||
| FaxNumber: | 6189975029 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2007 | ||||||||
| LastUpdateDate: | 07/23/2007 | ||||||||
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| AuthorizedOfficialLastName: | ADAMS | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6189975270 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | IL | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.