Provider Demographics
NPI:1275320285
Name:ADAMS, BENJAMIN MICHAEL
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:MICHAEL
Last Name:ADAMS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7342 S 1840 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-4883
Mailing Address - Country:US
Mailing Address - Phone:801-884-6353
Mailing Address - Fax:
Practice Address - Street 1:660 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1010
Practice Address - Country:US
Practice Address - Phone:314-362-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program