Provider Demographics
NPI:1932257623
Name:KING, ADAM GIDEON (MS, MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:GIDEON
Last Name:KING
Suffix:
Gender:M
Credentials:MS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6316 N BERKELEY BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH BAY
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4333
Mailing Address - Country:US
Mailing Address - Phone:414-803-5138
Mailing Address - Fax:
Practice Address - Street 1:1271 N 6TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-3360
Practice Address - Country:US
Practice Address - Phone:414-978-9100
Practice Address - Fax:414-978-9112
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51304208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics