Healthcare Provider Details

I. General information

NPI: 1841298643
Provider Name (Legal Business Name): HEIKO B ADAMS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 11/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 MIDLAND TRL
SHELBYVILLE KY
40065-1711
US

IV. Provider business mailing address

1701 MIDLAND TRAIL
SHELBYVILLE KY
40065-1711
US

V. Phone/Fax

Practice location:
  • Phone: 502-633-3338
  • Fax: 502-633-2704
Mailing address:
  • Phone: 502-633-3338
  • Fax: 502-633-2704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number00286
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number00286
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License Number00286
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number286
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number00286
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: