Provider Demographics
NPI:1114224987
Name:PRICKETT, ADAM LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:LEE
Last Name:PRICKETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1588 N ARLINGTON HEIGHTS ROAD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004
Mailing Address - Country:US
Mailing Address - Phone:847-392-9220
Mailing Address - Fax:847-392-9252
Practice Address - Street 1:1588 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-3906
Practice Address - Country:US
Practice Address - Phone:847-392-9220
Practice Address - Fax:847-392-9252
Is Sole Proprietor?:No
Enumeration Date:2011-02-14
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014010406207W00000X
IL036.138056207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$Medicaid