Basic Information
| Provider Information | |||||||||
| NPI: | 1992769715 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORRADO | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 ILLINOIS AVE | ||||||||
| Address2: | |||||||||
| City: | STEVENS POINT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544813114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153465000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 900 ILLINOIS AVE | ||||||||
| Address2: | |||||||||
| City: | STEVENS POINT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544813114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153465000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2006 | ||||||||
| LastUpdateDate: | 08/10/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | A82470 | CA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 241584 | NY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 042.0013085 | VT | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 045844 | CT | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 241979 | MA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 31217 | AZ | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 65627-20 | WI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 956203 | 05 | AZ | MEDICAID |