Provider Demographics
NPI:1891887063
Name:ADRIATICO, CLAUDE L (MD)
Entity Type:Individual
Prefix:
First Name:CLAUDE
Middle Name:L
Last Name:ADRIATICO
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 1:416 E MONROE ST
Mailing Address - Street 2:STE. 200
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-2371
Mailing Address - Country:US
Mailing Address - Phone:574-232-8119
Mailing Address - Fax:574-288-0235
Practice Address - Street 1:416 E MONROE ST
Practice Address - Street 2:STE. 200
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-2371
Practice Address - Country:US
Practice Address - Phone:574-232-8119
Practice Address - Fax:574-288-0235
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35080148207L00000X
IN01065705A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHG85884Medicare UPIN