Healthcare Provider Details

I. General information

NPI: 1952946972
Provider Name (Legal Business Name): ADAM C DONNELLON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2019
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 S MAIN ST
CHELSEA MI
48118-1383
US

IV. Provider business mailing address

2000 GREEN RD STE 300
ANN ARBOR MI
48105-1575
US

V. Phone/Fax

Practice location:
  • Phone: 734-593-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601009581
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: