Provider Demographics
NPI:1386718765
Name:ADAM, GEORGE (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:ADAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4500 PARK GLEN ROAD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:SAINT LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4888
Mailing Address - Country:US
Mailing Address - Phone:952-767-7771
Mailing Address - Fax:952-767-7774
Practice Address - Street 1:4500 PARK GLEN ROAD
Practice Address - Street 2:SUITE 160
Practice Address - City:SAINT LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-4888
Practice Address - Country:US
Practice Address - Phone:952-767-7771
Practice Address - Fax:952-767-7774
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN360612084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN227225300Medicaid
MNC04179Medicare PIN
MNF71786Medicare UPIN
MN130001260Medicare ID - Type Unspecified