Healthcare Provider Details

I. General information

NPI: 1114301470
Provider Name (Legal Business Name): ADAM MICHAEL MCCORMICK PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6920 GATWICK DR SUITE 200
INDIANAPOLIS IN
46241-9504
US

IV. Provider business mailing address

3600 W BETHEL AVE
MUNCIE IN
47304-5407
US

V. Phone/Fax

Practice location:
  • Phone: 317-455-1064
  • Fax: 317-455-1204
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10001915A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: