Provider Demographics
NPI:1841871977
Name:ADAME, JUSTIN LEE (DPM)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:LEE
Last Name:ADAME
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:50 N PERRY ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-2217
Mailing Address - Country:US
Mailing Address - Phone:248-338-5392
Mailing Address - Fax:
Practice Address - Street 1:3301 S ALAMEDA ST STE 306
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1876
Practice Address - Country:US
Practice Address - Phone:361-884-3984
Practice Address - Fax:361-452-3262
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390200000X
TX692123213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program