Provider Demographics
NPI:1750009239
Name:MILES, ADAM CURTIS
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:CURTIS
Last Name:MILES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RAMONE
Other - Middle Name:JERAMY
Other - Last Name:MILES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:720 37TH ST SW
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-5505
Mailing Address - Country:US
Mailing Address - Phone:507-481-4720
Mailing Address - Fax:
Practice Address - Street 1:720 37TH ST SW
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-5505
Practice Address - Country:US
Practice Address - Phone:507-481-4720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNW293246633114172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1411253OtherU CARE