Provider Demographics
NPI:1457984189
Name:TODD, ADAM RICHARD (PA-C)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:RICHARD
Last Name:TODD
Suffix:
Gender:M
Credentials:PA-C
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1908 SHILOH DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60051-6353
Mailing Address - Country:US
Mailing Address - Phone:815-451-3389
Mailing Address - Fax:
Practice Address - Street 1:650 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:FORT RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442-4030
Practice Address - Country:US
Practice Address - Phone:785-240-7106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical