Provider Demographics
NPI:1477611044
Name:MACADAMS, MICHAEL R (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:MACADAMS
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 53487
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79453-3487
Mailing Address - Country:US
Mailing Address - Phone:806-793-4440
Mailing Address - Fax:806-793-4452
Practice Address - Street 1:2716 82ND ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1428
Practice Address - Country:US
Practice Address - Phone:806-793-4440
Practice Address - Fax:806-793-4452
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6163207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132193708Medicaid
TX0040KHOtherBCBS
TXP00089245OtherRAILROAD MEDICARE
TX100201111OtherFIRST CARE
TX0040KHOtherBCBS
TXA49677Medicare UPIN