Provider Demographics
NPI:1245610963
Name:ADELMAN, AVRAM ELI (MD)
Entity Type:Individual
Prefix:
First Name:AVRAM
Middle Name:ELI
Last Name:ADELMAN
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:PO BOX 75588
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-5588
Mailing Address - Country:US
Mailing Address - Phone:907-792-7920
Mailing Address - Fax:
Practice Address - Street 1:2751 DEBARR RD STE 360
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-6809
Practice Address - Country:US
Practice Address - Phone:907-792-7920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2115732085R0202X
MEMD244102085R0202X
IAMD-472502085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1245610963Medicaid
AK1741496Medicaid