MEDICARE: BRUCE E ADAMS DO & ASSOCIATES, P.C.

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	207Q00000X	Family Medicine Physician	5101004370	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1285639856	OTHER	INDIVIDUAL NPI
3	0855000074	OTHER	BCBS FAMILY PRACTICE ID

General Provider Information

NPI Number	:	1639177058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRUCE E ADAMS DO & ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	23421 RYAN RD
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48091-1927
Country	:	US
Telephone Number	:	586-756-1921
Fax Number	:

Provider Business Practice Location Address
First Line	:	23421 RYAN RD
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48091-1927
Country	:	US
Telephone Number	:	586-756-3111
Fax Number	:	586-756-1921

Authorized Official
Title or Position	:	PRINCIPLE PHYSICIAN
Name	:	DR. BRUCE E ADAMS
Credential	:	D.O.
Telephone Number	:	586-756-3111

Provider Enumeration Date	:	07/09/2005
Last Update Date	:	05/16/2008

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