Provider Demographics
NPI:1497721765
Name:ADAMS, BRETT (MD)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:ADAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11855 ULYSSES ST NE STE 110
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-3948
Mailing Address - Country:US
Mailing Address - Phone:763-581-0555
Mailing Address - Fax:763-581-0510
Practice Address - Street 1:11855 ULYSSES ST NE STE 110
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-3948
Practice Address - Country:US
Practice Address - Phone:763-581-0555
Practice Address - Fax:763-581-0510
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN46163207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH98937Medicare UPIN