Healthcare Provider Details

I. General information

NPI: 1548495534
Provider Name (Legal Business Name): GLORIA A ADJEKUM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2009
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 S COLUMBIA RD - ALTRU FAMILY MEDICINE CENTER
GRAND FORKS ND
58201
US

IV. Provider business mailing address

2401 DEMERS AVE
GRAND FORKS ND
58201
US

V. Phone/Fax

Practice location:
  • Phone: 701-795-2000
  • Fax: 212-939-4022
Mailing address:
  • Phone: 701-780-1891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11940
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: