Healthcare Provider Details

I. General information

NPI: 1457325540
Provider Name (Legal Business Name): ADAM J LOCKETZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7275 147TH ST W
APPLE VALLEY MN
55124-7808
US

IV. Provider business mailing address

7275 147TH ST W
APPLE VALLEY MN
55124-7808
US

V. Phone/Fax

Practice location:
  • Phone: 651-333-9133
  • Fax: 651-560-7013
Mailing address:
  • Phone: 651-333-9133
  • Fax: 651-560-7013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number44760
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: