Basic Information
| Provider Information | |||||||||
| NPI: | 1902161474 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRINQUE | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.P.M. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1558 E TRINITY BLVD | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361063609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3343963338 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1558 E TRINITY BLVD | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361063609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3343963338 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2012 | ||||||||
| LastUpdateDate: | 04/12/2018 | ||||||||
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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 | 213E00000X | PO3695 | FL | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | 213E00000X | 325 | AL | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 015136900 | 05 | FL | MEDICAID |