Provider Demographics
NPI:1255325726
Name:ADAR, ERIC (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:ADAR
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 1:6024 N LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH BAY
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4646
Mailing Address - Country:US
Mailing Address - Phone:414-671-9833
Mailing Address - Fax:866-504-7468
Practice Address - Street 1:6024 N LAKE DR
Practice Address - Street 2:
Practice Address - City:WHITEFISH BAY
Practice Address - State:WI
Practice Address - Zip Code:53217-4646
Practice Address - Country:US
Practice Address - Phone:414-671-9833
Practice Address - Fax:866-504-7468
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060534207P00000X
WI49959-20207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200514380Medicaid
INI18074Medicare UPIN
IN200514380Medicaid