Provider Demographics
NPI:1922005347
Name:ADAMS, MICHAEL DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DEAN
Last Name:ADAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:75 YELLOW CREEK RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-5235
Mailing Address - Country:US
Mailing Address - Phone:307-789-8290
Mailing Address - Fax:307-789-8975
Practice Address - Street 1:75 YELLOW CREEK RD
Practice Address - Street 2:SUITE 102
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-5235
Practice Address - Country:US
Practice Address - Phone:307-789-8290
Practice Address - Fax:307-789-8975
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2019-06-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT181920-8905207Q00000X
WY4371-A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY53D0977203OtherCLIA NUMBER
0004116106OtherAETNA
080014492OtherRAILROAD MEDICARE
WY103977600Medicaid
C12604OtherUPIN
WY02902001OtherBLUECROSS/BLUESHIELD CLIN
080014492OtherRAILROAD MEDICARE