Provider Demographics
NPI:1174511521
Name:ADAMOVSKY, DANIEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:ADAMOVSKY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 OAKWOOD FARMS CT
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-7901
Mailing Address - Country:US
Mailing Address - Phone:636-477-7300
Mailing Address - Fax:636-922-0884
Practice Address - Street 1:2318 HIGHWAY 94 SOUTH OUTER RD
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-8301
Practice Address - Country:US
Practice Address - Phone:636-477-7300
Practice Address - Fax:636-922-0884
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001015897213E00000X, 213ES0000X, 213ES0103X
MO213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK26036Medicare PIN