Healthcare Provider Details

I. General information

NPI: 1730274556
Provider Name (Legal Business Name): NOEMI ADAME MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NOEMI GAMEL

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 12/31/2019
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 N LAKE SHORE DR
CULVER IN
46511-1207
US

IV. Provider business mailing address

707 E CEDAR ST STE 200
SOUTH BEND IN
46617-2057
US

V. Phone/Fax

Practice location:
  • Phone: 574-335-7750
  • Fax: 574-335-0730
Mailing address:
  • Phone: 574-335-8700
  • Fax: 574-335-0741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5414460-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01075665A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: