Provider Demographics
NPI:1285650580
Name:KIBEL, ADAM S (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:S
Last Name:KIBEL
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 1:111 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-6002
Mailing Address - Country:US
Mailing Address - Phone:857-307-0896
Mailing Address - Fax:
Practice Address - Street 1:45 FRANCIS ST
Practice Address - Street 2:ASB II A2-300
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6105
Practice Address - Country:US
Practice Address - Phone:617-732-6325
Practice Address - Fax:617-566-3475
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO118553208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203997309Medicaid
MA110092248AMedicaid
MO203997309Medicaid
MA110092248AMedicaid
G46230Medicare UPIN
IL$$$$$$$$$Medicaid