Provider Demographics
NPI:1609852102
Name:ADAMS, BETH ALLISON (MD)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:ALLISON
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BETH
Other - Middle Name:ALLISON
Other - Last Name:EIKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8170 33RD AVE S # MS 21110Q
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 CURVE CREST BLVD W
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6040
Practice Address - Country:US
Practice Address - Phone:651-439-1234
Practice Address - Fax:651-275-3325
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI46384207Q00000X
MN39765207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34452300Medicaid
MN671029800Medicaid
MNG57502Medicare UPIN
MN671029800Medicaid
P00271136Medicare PIN
WI000256150Medicare PIN