Provider Demographics
NPI:1730146507
Name:WOZNIAK, ADAM R (DO)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:R
Last Name:WOZNIAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 505164
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-5164
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:
Practice Address - Street 1:290 CLIFT CT
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:MO
Practice Address - Zip Code:65672-5947
Practice Address - Country:US
Practice Address - Phone:417-336-4355
Practice Address - Fax:417-337-5141
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005014705207Q00000X
ARE4814207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5N643OtherBCBS
5N643OtherAR BCBS
AR163841003Medicaid
MO1730146507Medicaid
5N643Medicare UPIN
5N643OtherAR BCBS