MEDICARE: DR. DANIEL ADAMOVSKY DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	2001015897	MO
2	213EP1101X	Primary Podiatric Medicine Podiatrist	200105897	MO
3	213ES0000X	Sports Medicine Podiatrist	2001015897	MO
4	213ES0103X	Foot & Ankle Surgery Podiatrist	2001015897	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174511521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL ADAMOVSKY DPM

Provider Business Mailing Address
First Line	:	215 OAKWOOD FARMS CT
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63021-7901
Country	:	US
Telephone Number	:	636-477-7300
Fax Number	:	636-922-0884

Provider Business Practice Location Address
First Line	:	2318 HIGHWAY 94 SOUTH OUTER RD
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-8301
Country	:	US
Telephone Number	:	636-477-7300
Fax Number	:	636-922-0884

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	10/19/2007

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