Healthcare Provider Details

I. General information

NPI: 1629500194
Provider Name (Legal Business Name): ADAM KYLE TAFT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 BRAMHALL ST. MAINE MEDICAL CENTER DEPARTMENT OF ANESTHESIOLOGY
PORTLAND ME
04102
US

IV. Provider business mailing address

1200 E 3900 S
MILLCREEK UT
84124-1300
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-0111
  • Fax:
Mailing address:
  • Phone: 801-268-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number12818168-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: