Provider Demographics
NPI:1063472124
Name:ADLARD, JOHN M (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:ADLARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:757 45TH STREET
Mailing Address - Street 2:STE. 201
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2911
Mailing Address - Country:US
Mailing Address - Phone:219-934-2461
Mailing Address - Fax:219-934-2478
Practice Address - Street 1:761 45TH STREET
Practice Address - Street 2:STE. 110
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2893
Practice Address - Country:US
Practice Address - Phone:219-922-3020
Practice Address - Fax:219-922-3023
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2010-12-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01028396207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100188420AMedicaid
B29093Medicare UPIN
IN100188420AMedicaid