Provider Demographics
NPI:1174521595
Name:KURTIN, ADAM D (DO)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:D
Last Name:KURTIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 SE GOLDTREE DR
Mailing Address - Street 2:SUITE 102-104
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7582
Mailing Address - Country:US
Mailing Address - Phone:772-335-8446
Mailing Address - Fax:772-335-8499
Practice Address - Street 1:1400 SE GOLDTREE DR
Practice Address - Street 2:SUITE 102-104
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7582
Practice Address - Country:US
Practice Address - Phone:772-335-8446
Practice Address - Fax:772-335-8499
Is Sole Proprietor?:No
Enumeration Date:2005-07-09
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0008163208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261341700Medicaid
FLG40247Medicare UPIN
FL58968ZMedicare PIN