Healthcare Provider Details

I. General information

NPI: 1245335967
Provider Name (Legal Business Name): ROY S ADANIYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 E HUEBBE PKWY
BELOIT WI
53511-1842
US

IV. Provider business mailing address

2903 LAOLA PL
HONOLULU HI
96813-1038
US

V. Phone/Fax

Practice location:
  • Phone: 608-364-2293
  • Fax: 608-364-5452
Mailing address:
  • Phone: 808-722-9365
  • Fax: 808-536-2033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301102340
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number4301102340
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD-1806
License Number StateHI
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number54676-20
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number4301102340
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: