Basic Information
| Provider Information | |||||||||
| NPI: | 1770576555 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADAMS | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 PINE ST | ||||||||
| Address2: | |||||||||
| City: | ELDORADO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 629301634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182733361 | ||||||||
| FaxNumber: | 6182732571 | ||||||||
| Practice Location | |||||||||
| Address1: | 1101 26TH ST S | ||||||||
| Address2: | |||||||||
| City: | GREAT FALLS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 594055161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4064554690 | ||||||||
| FaxNumber: | 4064554752 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2005 | ||||||||
| LastUpdateDate: | 07/27/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 036103160 | IL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036103160 1 | 05 | IL | MEDICAID | 10027682 | 01 | IL | BLUE CROSS PROVIDER NUMBE | OTHER |