Healthcare Provider Details

I. General information

NPI: 1659909885
Provider Name (Legal Business Name): ADAM SEAN DEVINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 COON RAPIDS BLVD NW STE 120
COON RAPIDS MN
55433-4568
US

IV. Provider business mailing address

4040 COON RAPIDS BLVD NW STE 120
COON RAPIDS MN
55433-4568
US

V. Phone/Fax

Practice location:
  • Phone: 763-427-9980
  • Fax:
Mailing address:
  • Phone: 866-450-7999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: