Provider Demographics
NPI:1942248166
Name:ADKISON, MICHAEL G (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:ADKISON
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:PO BOX 3012
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32085-3012
Mailing Address - Country:US
Mailing Address - Phone:866-480-2246
Mailing Address - Fax:770-237-1124
Practice Address - Street 1:300 HEALTH PARK BLVD
Practice Address - Street 2:SUITE 5008
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-3707
Practice Address - Country:US
Practice Address - Phone:904-810-0686
Practice Address - Fax:770-237-1124
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97111207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1104903160OtherGROUP NPI NUMBER
FL276744900Medicaid
FLAB358ZMedicare PIN
FLI69937Medicare UPIN