Provider Demographics
NPI:1508842352
Name:ADAMS, DONALD G (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:G
Last Name:ADAMS
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 1:130 LINCOLN PLACE CT STE 130
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-5884
Mailing Address - Country:US
Mailing Address - Phone:618-257-1297
Mailing Address - Fax:
Practice Address - Street 1:130 LINCOLN PLACE CT STE 130
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62221-5884
Practice Address - Country:US
Practice Address - Phone:618-257-1297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036129376207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036129376Medicaid
NC0105902OtherUNITED HEALTHCARE
NCE2001OtherMEDCOST
NC806067OtherPARTNERS MEDICARE CHOICE
P00251903OtherRAIL ROAD MEDICARE
NC4115662OtherAETNA
NC139TVOtherBCBS
NC1549555OtherCIGNA
NC2439407867OtherCHAMPUS/TRICARE
NC5900917Medicaid
NC5900917Medicaid
NC806067OtherPARTNERS MEDICARE CHOICE
NC2439407867OtherCHAMPUS/TRICARE
ILA15217Medicare UPIN