Healthcare Provider Details

I. General information

NPI: 1073179594
Provider Name (Legal Business Name): JOSEPH THOMAS ADAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2019
Last Update Date: 06/30/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 W DEMPSTER ST
PARK RIDGE IL
60068-1186
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1166
US

V. Phone/Fax

Practice location:
  • Phone: 847-698-3600
  • Fax:
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036161563
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036161563
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: