MEDICARE: ADAM VANLIESHOUT

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	363AM0700X	Medical Physician Assistant	MA057983	PA

General Provider Information

NPI Number	:	1972969053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM VANLIESHOUT

Provider Business Mailing Address
First Line	:	300 HALKET ST STE 1731
Second Line	:	SUITE 1731
City	:	PITTSBURGH
State	:	PA
Zip	:	15213-3108
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 HALKET ST STE 1731
Second Line	:	SUITE 1731
City	:	PITTSBURGH
State	:	PA
Zip	:	15213-3108
Country	:	US
Telephone Number	:	412-641-1000
Fax Number	:

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

Provider Enumeration Date	:	01/05/2016
Last Update Date	:	04/06/2021

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Directions to “ ADAM VANLIESHOUT ” Practice Location

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