Provider Demographics
NPI:1033293659
Name:ADLER, MATTHEW F (PA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:F
Last Name:ADLER
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:6888 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-9345
Mailing Address - Country:US
Mailing Address - Phone:810-220-4422
Mailing Address - Fax:810-220-1123
Practice Address - Street 1:2300 GENOA BUSINESS PARK DR
Practice Address - Street 2:SUITE 220
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-7367
Practice Address - Country:US
Practice Address - Phone:810-220-4422
Practice Address - Fax:810-225-4696
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2016-10-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI561003547363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N97430Medicare ID - Type Unspecified