Basic Information
Provider Information
NPI: 1548882368
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ADAPA
FirstName: NIKHIL
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 44998 PAINE DR
Address2:  
City: NOVI
State: MI
PostalCode: 483772557
CountryCode: US
TelephoneNumber: 2484693935
FaxNumber:  
Practice Location
Address1: 750 E ADAMS ST
Address2:  
City: SYRACUSE
State: NY
PostalCode: 132102306
CountryCode: US
TelephoneNumber: 3154641800
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/14/2020
LastUpdateDate: 05/14/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/14/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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