Provider Demographics
NPI:1548569403
Name:ADAM INTERNAL MEDICINE PLLC
Entity Type:Organization
Organization Name:ADAM INTERNAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:HOREISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-225-6594
Mailing Address - Street 1:PO BOX 2240
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85299-2240
Mailing Address - Country:US
Mailing Address - Phone:623-225-6594
Mailing Address - Fax:
Practice Address - Street 1:5656 S POWER RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-8487
Practice Address - Country:US
Practice Address - Phone:623-225-6594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-17
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ604300Medicaid
AZ604300Medicaid