Healthcare Provider Details

I. General information

NPI: 1437197555
Provider Name (Legal Business Name): MATTHEW DAVID ADAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 W 13 MILE RD STE 707
ROYAL OAK MI
48073-6770
US

IV. Provider business mailing address

4201 ST. ANTOINE UHC 5D UNIVERSITY PEDIATRICIANS
DETROIT MI
48201
US

V. Phone/Fax

Practice location:
  • Phone: 248-551-0487
  • Fax:
Mailing address:
  • Phone: 313-966-5051
  • Fax: 313-966-0665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301070595
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number4301070595
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: