Provider Demographics
NPI:1063790939
Name:CHORNOBY, ADAM EDWARD (DO)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:EDWARD
Last Name:CHORNOBY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6245 INKSTER RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-4001
Mailing Address - Country:US
Mailing Address - Phone:734-261-9211
Mailing Address - Fax:
Practice Address - Street 1:30626 FORD RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-1870
Practice Address - Country:US
Practice Address - Phone:734-261-9211
Practice Address - Fax:734-261-8537
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-26
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101019206207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty