MEDICARE: DR. ADAM STIVALA MD

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	171000000X	Military Health Care Provider
2	2084P0800X	Psychiatry Physician	25MA10502700	NJ
3	2084P0800X	Psychiatry Physician	MED-PHYS-LIC-79647	MT
4	2084P0800X	Psychiatry Physician	ME142842	FL
5	2084P0800X	Psychiatry Physician	A197909	CA
6	2084P0800X	Psychiatry Physician	MD-20270	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467738617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADAM STIVALA MD

Provider Business Mailing Address
First Line	:	86-260 FARRINGTON HWY
Second Line	:
City	:	WAIANAE
State	:	HI
Zip	:	96792-3128
Country	:	US
Telephone Number	:	808-697-3300
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 N FRANKLIN ST STE 401
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-7212
Country	:	US
Telephone Number	:	856-288-9612
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2011
Last Update Date	:	03/12/2025

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Directions to “ DR. ADAM STIVALA MD” Practice Location

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