Provider Demographics
NPI:1689660185
Name:ADAIR, ROY (MD)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:
Last Name:ADAIR
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 1:4400 W 95TH ST
Mailing Address - Street 2:STE 306
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2659
Mailing Address - Country:US
Mailing Address - Phone:708-684-5428
Mailing Address - Fax:708-684-2079
Practice Address - Street 1:4400 W 95TH ST STE 306
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2659
Practice Address - Country:US
Practice Address - Phone:708-684-5428
Practice Address - Fax:708-684-2079
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036067096208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036067096Medicaid
IL01621490OtherBCBS PROVIDER ID
IL250002468OtherRAILROAD MEDICARE
IL131667300OtherWORKERS COMP
IL036067096Medicaid
IL131667300OtherWORKERS COMP
IL01621490OtherBCBS PROVIDER ID