Provider Demographics
NPI:1932363587
Name:WILL, ADAM D (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:D
Last Name:WILL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3702 NEW VISION DR
Mailing Address - Street 2:BLDG B
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1703
Mailing Address - Country:US
Mailing Address - Phone:260-266-1401
Mailing Address - Fax:260-458-5734
Practice Address - Street 1:8911 LIBERTY MILLS RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-6311
Practice Address - Country:US
Practice Address - Phone:260-373-9465
Practice Address - Fax:260-266-9406
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2018-12-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301092926208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201037140Medicaid
M400071327Medicare PIN