Provider Demographics
NPI:1235107012
Name:ADAMS, MICHAEL J (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:ADAMS
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 1:425 MONITOR WAY
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-8461
Mailing Address - Country:US
Mailing Address - Phone:636-441-5033
Mailing Address - Fax:
Practice Address - Street 1:408 JUNGERMANN RD
Practice Address - Street 2:
Practice Address - City:ST PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-2799
Practice Address - Country:US
Practice Address - Phone:636-449-5757
Practice Address - Fax:636-449-5750
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6B55207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO010027OtherMEDICARE COMPLETE
MO2287OtherGROUP HEALTH PLAN (GHP)
MO40513OtherHEALTHCARE USA
MO4057727OtherAETNA
MO108057OtherHEALTHLINK
MO9684OtherBCBS
MOD41488OtherMERCY HEALTH PLANS
MO241738210Medicaid
MOPC10113OtherCIGNA
MO010027OtherMEDICARE COMPLETE
MOPC10113OtherCIGNA