Provider Demographics
NPI:1720069479
Name:ADAMS, THOMAS MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:MICHAEL
Last Name:ADAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:T MICHEAL
Other - Middle Name:
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1000 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-9303
Mailing Address - Country:US
Mailing Address - Phone:270-759-9200
Mailing Address - Fax:270-759-9966
Practice Address - Street 1:1000 S 12TH ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-9303
Practice Address - Country:US
Practice Address - Phone:270-759-9200
Practice Address - Fax:270-759-9966
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28935207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY080052100OtherRAILROAD MEDICARE PROV NU
KY64289358Medicaid
KY000000050314OtherANTHEM PROV NUMBER
KYF76801Medicare UPIN
KY0283205Medicare PIN