=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437197555
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MATTHEW DAVID ADAMS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2006
-----------------------------------------------------
Last Update Date | 11/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3535 W 13 MILE RD STE 707
-----------------------------------------------------
City | ROYAL OAK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48073-6770
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-551-0487
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4201 ST. ANTOINE UHC 5D UNIVERSITY PEDIATRICIANS
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-966-5051
-----------------------------------------------------
Fax | 313-966-0665
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 4301070595
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2080P0216X
-----------------------------------------------------
Taxonomy Name | Pediatric Rheumatology Physician
-----------------------------------------------------
License Number | 4301070595
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------