Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301070595 | MI |
Y | 2080P0216X | Pediatric Rheumatologist | 4301070595 | MI |
NPI | 1437197555 |
---|---|
Provider Name | Matthew David Adams |
First Address | Detroit, MI 48201 |
Second Address | Detroit, MI 48201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 15/10/2012 |