Healthcare Provider Details

I. General information

NPI: 1063472124
Provider Name (Legal Business Name): JOHN M ADLARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 45TH STREET STE. 110
MUNSTER IN
46321-2893
US

IV. Provider business mailing address

757 45TH STREET STE. 201
MUNSTER IN
46321-2911
US

V. Phone/Fax

Practice location:
  • Phone: 219-922-3020
  • Fax: 219-922-3023
Mailing address:
  • Phone: 219-934-2461
  • Fax: 219-934-2478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number01028396
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: