MEDICARE: DR. MICHAEL DEAN ADAMS M.D.

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	181920-8905	UT
2	207Q00000X	Family Medicine Physician	4371-A	WY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	080014492	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	53D0977203	OTHER	WY	CLIA NUMBER
2	0004116106	OTHER		AETNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	C12604	OTHER		UPIN
6	02902001	OTHER	WY	BLUECROSS/BLUESHIELD CLIN

General Provider Information

NPI Number	:	1922005347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL DEAN ADAMS M.D.

Provider Business Mailing Address
First Line	:	75 YELLOW CREEK RD
Second Line	:	SUITE 102
City	:	EVANSTON
State	:	WY
Zip	:	82930-5235
Country	:	US
Telephone Number	:	307-789-8290
Fax Number	:	307-789-8975

Provider Business Practice Location Address
First Line	:	75 YELLOW CREEK RD
Second Line	:	SUITE 102
City	:	EVANSTON
State	:	WY
Zip	:	82930-5235
Country	:	US
Telephone Number	:	307-789-8290
Fax Number	:	307-789-8975

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	06/13/2019

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Directions to “ DR. MICHAEL DEAN ADAMS M.D.” Practice Location

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