Healthcare Provider Details

I. General information

NPI: 1124225255
Provider Name (Legal Business Name): CARLO E ADAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20870 MACK AVE
GROSSE POINTE WOODS MI
48236-1388
US

IV. Provider business mailing address

1559 BRENTWOOD DR
TROY MI
48098-2710
US

V. Phone/Fax

Practice location:
  • Phone: 313-885-2334
  • Fax: 249-928-0300
Mailing address:
  • Phone: 248-550-3203
  • Fax: 248-928-0300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberE-7148
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number4301090600
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number4301090600
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number4301090600
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: