Provider Demographics
NPI:1841588837
Name:AU, ADAM MAXWELL (DO MD PHDFACOI)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:MAXWELL
Last Name:AU
Suffix:
Gender:M
Credentials:DO MD PHDFACOI
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2040 NE 163RD ST STE 204
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-4953
Mailing Address - Country:US
Mailing Address - Phone:305-720-4004
Mailing Address - Fax:305-675-8491
Practice Address - Street 1:2040 NE 163RD ST STE 204
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4953
Practice Address - Country:US
Practice Address - Phone:305-720-4004
Practice Address - Fax:305-675-8491
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11940207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100892400Medicaid