Provider Demographics
NPI:1962407429
Name:ADJOVU, SETH K (MD)
Entity type:Individual
Prefix:DR
First Name:SETH
Middle Name:K
Last Name:ADJOVU
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:PO BOX 33269
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85067-3269
Mailing Address - Country:US
Mailing Address - Phone:602-406-4786
Mailing Address - Fax:916-636-4358
Practice Address - Street 1:1550 W CRAIG RD STE 220
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-0329
Practice Address - Country:US
Practice Address - Phone:702-602-7828
Practice Address - Fax:702-399-8431
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10335208000000X, 208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV3102988Medicaid
AZ184241Medicaid
NV100500484 GROUPMedicaid
NV2018988Medicaid
NV100500484 GROUPMedicaid
AZZ154205Medicare PIN
NV3102988Medicaid