Provider Demographics
NPI:1659698207
Name:ADAMS, MICHAEL JACOB (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JACOB
Last Name:ADAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 GILLETTE ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14619-2227
Mailing Address - Country:US
Mailing Address - Phone:585-275-5951
Mailing Address - Fax:585-756-7775
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-8644
Practice Address - Country:US
Practice Address - Phone:585-273-2590
Practice Address - Fax:585-756-7775
Is Sole Proprietor?:No
Enumeration Date:2010-04-22
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program