MEDICARE: JEFFERY S ADAM MD

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	207Y00000X	Otolaryngology Physician	35.042734	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	000000003863	OTHER	ANTHEM
2	D42734	OTHER	HUMANA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	0640419	OTHER	AETNA
5	290420811006	OTHER	MEDICAL MUTUAL
6	1020049	OTHER	UNITEDHEALTHCARE

General Provider Information

NPI Number	:	1326019613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFERY S ADAM MD

Provider Business Mailing Address
First Line	:	3170 KETTERING BLVD
Second Line	:
City	:	MORAINE
State	:	OH
Zip	:	45439-1924
Country	:	US
Telephone Number	:	937-991-3188
Fax Number	:	937-223-9811

Provider Business Practice Location Address
First Line	:	31 S STANFIELD RD
Second Line	:	STE 304
City	:	TROY
State	:	OH
Zip	:	45373-2374
Country	:	US
Telephone Number	:	937-440-7872
Fax Number	:	937-440-7874

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

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	06/03/2019

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Directions to “ JEFFERY S ADAM MD” Practice Location

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