Provider Demographics
NPI:1578674503
Name:ADAMS, ANDREA MICHELE (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:MICHELE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 W 121ST ST S
Mailing Address - Street 2:
Mailing Address - City:GLENPOOL
Mailing Address - State:OK
Mailing Address - Zip Code:74033-8677
Mailing Address - Country:US
Mailing Address - Phone:918-291-5200
Mailing Address - Fax:918-291-5929
Practice Address - Street 1:550 W 121ST ST S
Practice Address - Street 2:
Practice Address - City:GLENPOOL
Practice Address - State:OK
Practice Address - Zip Code:74033-8677
Practice Address - Country:US
Practice Address - Phone:918-291-5200
Practice Address - Fax:918-291-5929
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4170207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200097180AMedicaid
OK200097180AMedicaid