Healthcare Provider Details

I. General information

NPI: 1790709111
Provider Name (Legal Business Name): MICHAEL L ADIX DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 EARL ROAD
SHELBY NC
28150
US

IV. Provider business mailing address

3152 LITTLE ROAD, SUITE 115
TRINITY FL
34655
US

V. Phone/Fax

Practice location:
  • Phone: 704-481-0555
  • Fax: 704-481-9169
Mailing address:
  • Phone: 727-510-7536
  • Fax: 727-494-7421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2011040029
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9401112
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: