Provider Demographics
NPI:1598386880
Name:HOMAN, ADAM J
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:J
Last Name:HOMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:OH
Mailing Address - Zip Code:45828-1001
Mailing Address - Country:US
Mailing Address - Phone:419-852-1786
Mailing Address - Fax:
Practice Address - Street 1:202 BRIARWOOD DR
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:OH
Practice Address - Zip Code:45828-1001
Practice Address - Country:US
Practice Address - Phone:419-852-1786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant