Provider Demographics
NPI:1699490433
Name:ADAM, ADAM KAMAL (DRIVER)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:KAMAL
Last Name:ADAM
Suffix:
Gender:M
Credentials:DRIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W LAKE ST APT 409
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-3153
Mailing Address - Country:US
Mailing Address - Phone:612-481-0352
Mailing Address - Fax:
Practice Address - Street 1:1 W LAKE ST APT 409
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-3153
Practice Address - Country:US
Practice Address - Phone:612-481-0352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNM533128232511172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver