MEDICARE: MICHAEL W ADAMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center		IL

General Provider Information

NPI Number	:	1205036696
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL W ADAMS

Provider Business Mailing Address
First Line	:	1506 SIOUX DR
Second Line	:
City	:	MARION
State	:	IL
Zip	:	62959-5209
Country	:	US
Telephone Number	:	618-997-5270
Fax Number	:	618-997-5029

Provider Business Practice Location Address
First Line	:	1506 SIOUX DR
Second Line	:
City	:	MARION
State	:	IL
Zip	:	62959-5209
Country	:	US
Telephone Number	:	618-997-5270
Fax Number	:	618-997-5029

Authorized Official
Title or Position	:	CEO
Name	:	MICHAEL W ADAMS
Credential	:	MD
Telephone Number	:	618-997-5270

Provider Enumeration Date	:	07/23/2007
Last Update Date	:	07/23/2007

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