Provider Demographics
NPI:1932363587
Name:WILL, ADAM D (MD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:D
Last Name:WILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 W MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BERNE
Mailing Address - State:IN
Mailing Address - Zip Code:46711-1797
Mailing Address - Country:US
Mailing Address - Phone:260-589-2312
Mailing Address - Fax:260-589-3941
Practice Address - Street 1:1521 W MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:BERNE
Practice Address - State:IN
Practice Address - Zip Code:46711-1797
Practice Address - Country:US
Practice Address - Phone:260-589-2312
Practice Address - Fax:260-589-3941
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01071052207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201037140Medicaid
M400071327Medicare PIN