Healthcare Provider Details

I. General information

NPI: 1679758080
Provider Name (Legal Business Name): DAVID H ADAMS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 HOBART ST
CADILLAC MI
49601-2379
US

IV. Provider business mailing address

PO BOX 1024
CADILLAC MI
49601-6024
US

V. Phone/Fax

Practice location:
  • Phone: 231-775-8814
  • Fax: 231-775-8854
Mailing address:
  • Phone: 231-775-6076
  • Fax: 231-775-0027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601005035
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: