Provider Demographics
NPI:1639177058
Name:BRUCE E ADAMS DO & ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:BRUCE E ADAMS DO & ASSOCIATES, P.C.
Other - Org Name:DR BRUCE E ADAMS DO
Other - Org Type:Other Name
Authorized Official - Title/Position:PRINCIPLE PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-756-3111
Mailing Address - Street 1:23421 RYAN RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-1927
Mailing Address - Country:US
Mailing Address - Phone:586-756-1921
Mailing Address - Fax:
Practice Address - Street 1:23421 RYAN RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-1927
Practice Address - Country:US
Practice Address - Phone:586-756-3111
Practice Address - Fax:586-756-1921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-09
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101004370207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1015886Medicaid
1285639856OtherINDIVIDUAL NPI
0855000074OtherBCBS FAMILY PRACTICE ID
5500007Medicare PIN
E25541Medicare UPIN