Provider Demographics
NPI:1124027230
Name:DANCHENKO, ADRIAN MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:MICHAEL
Last Name:DANCHENKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-1726
Mailing Address - Country:US
Mailing Address - Phone:931-372-0405
Mailing Address - Fax:931-372-0463
Practice Address - Street 1:228 W 4TH ST STE 200
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2489
Practice Address - Country:US
Practice Address - Phone:931-372-0405
Practice Address - Fax:931-372-0463
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN53777207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ036399Medicaid
TN53777OtherMEDICAL LICENSE
FL267700800Medicaid
FL267700800Medicaid
78628ZMedicare ID - Type Unspecified
FLME86807OtherMEDICAL LICENSE