Provider Demographics
NPI:1225219330
Name:PENTEL, ADAM PATRICK (DO)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:PATRICK
Last Name:PENTEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 N CLARKSON ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-7718
Mailing Address - Country:US
Mailing Address - Phone:810-449-7020
Mailing Address - Fax:
Practice Address - Street 1:10512 EDGEWATER TRL
Practice Address - Street 2:
Practice Address - City:HOLLY
Practice Address - State:MI
Practice Address - Zip Code:48442-9340
Practice Address - Country:US
Practice Address - Phone:810-449-7020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017156208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery