Healthcare Provider Details

I. General information

NPI: 1710621958
Provider Name (Legal Business Name): LUCAS SCOT ADAMS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 FORD ST
MAUMEE OH
43537-1947
US

IV. Provider business mailing address

609 FORD ST
MAUMEE OH
43537-1947
US

V. Phone/Fax

Practice location:
  • Phone: 419-893-5539
  • Fax: 419-893-6853
Mailing address:
  • Phone: 419-893-5539
  • Fax: 419-893-6853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36.004189
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: