Healthcare Provider Details

I. General information

NPI: 1043257561
Provider Name (Legal Business Name): ADI MICHELLE PHILPOTT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 LEONARD ST
PORTLAND ME
04103-2512
US

IV. Provider business mailing address

37 LEONARD ST
PORTLAND ME
04103-2512
US

V. Phone/Fax

Practice location:
  • Phone: 207-370-8045
  • Fax: 636-851-2820
Mailing address:
  • Phone: 207-370-8045
  • Fax: 636-851-2820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number1860
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1860
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: