Provider Demographics
NPI:1205107422
Name:HETZ, ADAM ROBERT (PAC)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:ROBERT
Last Name:HETZ
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 SPRINGER DR
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6413
Mailing Address - Country:US
Mailing Address - Phone:815-744-8554
Mailing Address - Fax:
Practice Address - Street 1:10705 TOWN SQUARE DR NE STE 210
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-8187
Practice Address - Country:US
Practice Address - Phone:763-231-8700
Practice Address - Fax:763-427-8131
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant