Healthcare Provider Details

I. General information

NPI: 1003875303
Provider Name (Legal Business Name): ADAM C ANKRUM D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E WISCONSIN AVE SUITE 2000
MILWAUKEE WI
53202-4815
US

IV. Provider business mailing address

111 E WISCONSIN AVE SUITE 2000
MILWAUKEE WI
53202-4815
US

V. Phone/Fax

Practice location:
  • Phone: 414-290-6720
  • Fax: 414-290-6755
Mailing address:
  • Phone: 414-290-6720
  • Fax: 414-290-6755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number46620
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDOS-1523
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: