MEDICARE: KIWANA ADKINS

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	172A00000X	Driver

General Provider Information

NPI Number	:	1730923277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIWANA ADKINS

Provider Business Mailing Address
First Line	:	2017 NORCROSS CIR APT D
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-5048
Country	:	US
Telephone Number	:	317-334-5081
Fax Number	:

Provider Business Practice Location Address
First Line	:	2017 NORCROSS CIR APT D
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-5048
Country	:	US
Telephone Number	:	317-334-5081
Fax Number	:

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

Provider Enumeration Date	:	06/20/2024
Last Update Date	:	06/20/2024

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Directions to “ KIWANA ADKINS ” Practice Location

Language	Start Address	Practice Location

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