Healthcare Provider Details

I. General information

NPI: 1932257623
Provider Name (Legal Business Name): ADAM GIDEON KING MS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 02/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1271 N 6TH ST
MILWAUKEE WI
53212-3360
US

IV. Provider business mailing address

6316 N BERKELEY BLVD
WHITEFISH BAY WI
53217-4333
US

V. Phone/Fax

Practice location:
  • Phone: 414-978-9100
  • Fax: 414-978-9112
Mailing address:
  • Phone: 414-803-5138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number51304
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number51304
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: