Healthcare Provider Details

I. General information

NPI: 1063929255
Provider Name (Legal Business Name): ADAM C HEMINGWAY DTELLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 AXTELL DR STE 100
TROY MI
48084-4400
US

IV. Provider business mailing address

9341 N STATE RD
OTISVILLE MI
48463-9457
US

V. Phone/Fax

Practice location:
  • Phone: 248-862-1178
  • Fax:
Mailing address:
  • Phone: 810-728-3219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6352000502
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: