Provider Demographics
NPI:1972589042
Name:ADE, DAVID THOMAS (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:THOMAS
Last Name:ADE
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 1:870 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-7159
Mailing Address - Country:US
Mailing Address - Phone:309-623-7100
Mailing Address - Fax:309-623-7079
Practice Address - Street 1:870 36TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-7159
Practice Address - Country:US
Practice Address - Phone:309-623-7100
Practice Address - Fax:309-623-7079
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062963207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036062963Medicaid
ILD15061Medicare UPIN