Healthcare Provider Details

I. General information

NPI: 1083692255
Provider Name (Legal Business Name): HEATHER M ADAMS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER MARIE BELLOW M.D.

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 01/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W GREENLAWN AVE
LANSING MI
48910-2819
US

IV. Provider business mailing address

12800 WARM CREEK DR
DEWITT MI
48820-7865
US

V. Phone/Fax

Practice location:
  • Phone: 517-975-7578
  • Fax:
Mailing address:
  • Phone: 517-881-7887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301076471
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: