Provider Demographics
NPI:1730274556
Name:ADAME, NOEMI (MD)
Entity type:Individual
Prefix:
First Name:NOEMI
Middle Name:
Last Name:ADAME
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NOEMI
Other - Middle Name:
Other - Last Name:GAMEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:707 E CEDAR ST
Mailing Address - Street 2:STE 200
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2057
Mailing Address - Country:US
Mailing Address - Phone:574-335-8700
Mailing Address - Fax:574-335-0741
Practice Address - Street 1:921 N LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:CULVER
Practice Address - State:IN
Practice Address - Zip Code:46511-1207
Practice Address - Country:US
Practice Address - Phone:574-335-7750
Practice Address - Fax:574-335-0730
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5414460-1205208000000X
IN01075665A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
176666902OtherCIDC
TX176666901Medicaid
IN000000951586OtherBCBS SAINT JOSEPH HEALTH CENTER
176666902OtherCIDC
IN000000951472OtherBCBS LAKE SHORE CLINIC
IN000000951481OtherBCBS PLYMOUTH FAMILY AND INTERNAL MEDICINE
TX176666901Medicaid
IN201306980Medicaid
TX176666901Medicaid
8G0648Medicare PIN
IN000000951480OtherBCBS MARSHALL COUNTY PEDIATRIC PHYSICIANS
IN000000951481OtherBCBS PLYMOUTH FAMILY AND INTERNAL MEDICINE
IN187730030Medicare PIN