Provider Demographics
NPI:1538152764
Name:KOUYOUMJIAN, ADAM L (DO)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:L
Last Name:KOUYOUMJIAN
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 1:4031 W PLANO PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5617
Mailing Address - Country:US
Mailing Address - Phone:972-985-1072
Mailing Address - Fax:972-596-5382
Practice Address - Street 1:4031 W PLANO PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5617
Practice Address - Country:US
Practice Address - Phone:972-985-1072
Practice Address - Fax:972-596-5382
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0353207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CR153OtherBCBS TX 02/01/11
TXP00913353OtherMEDICARE RAILROAD - EFFECT 02/01/2011
TXTXB118174Medicare PIN
TX88355JMedicare ID - Type Unspecified
TX6484850002Medicare NSC
TXP00913353OtherMEDICARE RAILROAD - EFFECT 02/01/2011
TXH37569Medicare UPIN