Provider Demographics
NPI:1609866797
Name:BOX, ADAM J (PAC)
Entity Type:Individual
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First Name:ADAM
Middle Name:J
Last Name:BOX
Suffix:
Gender:M
Credentials:PAC
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Mailing Address - Street 1:3906 THOMAS AVE S
Mailing Address - Street 2:APARTMENT 4
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-1236
Mailing Address - Country:US
Mailing Address - Phone:612-590-4866
Mailing Address - Fax:612-333-1026
Practice Address - Street 1:900 NICOLLET MALL
Practice Address - Street 2:TARGET CLINIC
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-2530
Practice Address - Country:US
Practice Address - Phone:612-338-0085
Practice Address - Fax:612-333-1026
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MEPA810207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME403180099Medicaid
ME403180099Medicaid
AP2067Medicare ID - Type Unspecified