Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 2001015897 | MO |
N | 222Z00000X | Podiatrist | 2001015897 | MO |
N | 213EP1101X | Primary Podiatric Medicine | MO | |
N | 2081S0010X | Sports Medicine | 2001015897 | MO |
N | 213ES0000X | Sports Medicine | 2001015897 | MO |
Y | 213ES0103X | Foot & Ankle Surgery | 2001015897 | MO |
NPI | 1174511521 |
---|---|
Provider Name | Dr. Daniel Adamovsky |
First Address | Ballwin, MO 63021-7901 |
Second Address | Saint Charles, MO 63303-8301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2005 |
Last Update Date | 19/10/2007 |