Provider Demographics
NPI:1457325540
Name:LOCKETZ, ADAM J (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:J
Last Name:LOCKETZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:7275 147TH ST W
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-7808
Mailing Address - Country:US
Mailing Address - Phone:651-333-9133
Mailing Address - Fax:651-560-7013
Practice Address - Street 1:7275 147TH ST W
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7808
Practice Address - Country:US
Practice Address - Phone:651-333-9133
Practice Address - Fax:651-560-7013
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN447602081P2900X, 208VP0000X, 2081P0004X, 207LP2900X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34536300Medicaid
MN530615900Medicaid
MN090000028Medicare PIN
H66508Medicare UPIN