Healthcare Provider Details

I. General information

NPI: 1427090448
Provider Name (Legal Business Name): MARK ADAMS M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 MACKINAW RD SUITE 2300
SAGINAW MI
48604-9515
US

IV. Provider business mailing address

5400 MACKINAW RD SUITE 2300
SAGINAW MI
48604-9515
US

V. Phone/Fax

Practice location:
  • Phone: 989-753-4000
  • Fax: 989-754-4000
Mailing address:
  • Phone: 989-753-4000
  • Fax: 989-754-4000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number4301059376
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: