Provider Demographics
NPI:1972571545
Name:MYERS, ADAM MICHAEL (DPM)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:MICHAEL
Last Name:MYERS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 UNION AVE
Mailing Address - Street 2:#147
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-3004
Mailing Address - Country:US
Mailing Address - Phone:330-339-6233
Mailing Address - Fax:330-343-8460
Practice Address - Street 1:515 UNION AVE
Practice Address - Street 2:#147
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-3004
Practice Address - Country:US
Practice Address - Phone:330-339-6233
Practice Address - Fax:330-343-8460
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003164M213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9378401OtherMEDICARE
OHP00653532OtherRAILROAD
OH2868884Medicaid
OH2236075Medicaid
OH000000579652OtherANTHEM
OH9378401OtherMEDICARE
OH2236075Medicaid
OH9339963Medicare ID - Type Unspecified
OH5378920001Medicare NSC
OH5378920003Medicare NSC