Provider Demographics
NPI:1750577524
Name:ANDERSON, ADAM ELLIOTT (DPT)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:ELLIOTT
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33900 HARPER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-350-2644
Mailing Address - Fax:586-541-3735
Practice Address - Street 1:1077 E GOLF RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4271
Practice Address - Country:US
Practice Address - Phone:847-305-1400
Practice Address - Fax:847-305-1556
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7930225100000X
IL070-016056225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00609016Medicare PIN
ILR01260Medicare PIN
ILR00355Medicare PIN
IL216859015Medicare PIN