Provider Demographics
NPI:1023096880
Name:ADAMS, TIM GARDINER JR (MD)
Entity type:Individual
Prefix:
First Name:TIM
Middle Name:GARDINER
Last Name:ADAMS
Suffix:JR
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 1:401 N HOOPER ST
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-1476
Mailing Address - Country:US
Mailing Address - Phone:989-672-5079
Mailing Address - Fax:
Practice Address - Street 1:401 N HOOPER RD
Practice Address - Street 2:CARO COMMUNITY HOSPITAL
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723
Practice Address - Country:US
Practice Address - Phone:989-673-3151
Practice Address - Fax:989-673-5508
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301405797207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI10-2716296Medicaid
MI10-2784732Medicaid
MI10-4211380Medicaid
MI10-4211371Medicaid
MI0108290702OtherBCBS
MI10-2796448Medicaid
MI10-4104522Medicaid
MI10-4104531Medicaid
MI10-4104540Medicaid
MI0108290702OtherBCBS
MI10-4104531Medicaid
MI10-2784732Medicaid