Provider Demographics
NPI:1427655604
Name:ADANG, MARK ROBERT (BA)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ROBERT
Last Name:ADANG
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-4750
Mailing Address - Country:US
Mailing Address - Phone:260-442-4409
Mailing Address - Fax:
Practice Address - Street 1:1825 BEACON ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4750
Practice Address - Country:US
Practice Address - Phone:260-442-4409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator