Healthcare Provider Details

I. General information

NPI: 1528362258
Provider Name (Legal Business Name): ABDULMAJID ADAM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 09/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 N WESTHAVEN DR
OSHKOSH WI
54904-7668
US

IV. Provider business mailing address

855 N WESTHAVEN DR
OSHKOSH WI
54904-7668
US

V. Phone/Fax

Practice location:
  • Phone: 862-218-4482
  • Fax:
Mailing address:
  • Phone: 862-218-4482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35122847
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number55649-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: