Provider Demographics
NPI:1083473003
Name:HENN, ADLER DAVID (ATS)
Entity Type:Individual
Prefix:
First Name:ADLER
Middle Name:DAVID
Last Name:HENN
Suffix:
Gender:M
Credentials:ATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 S BURRELL ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-2033
Mailing Address - Country:US
Mailing Address - Phone:414-218-9111
Mailing Address - Fax:
Practice Address - Street 1:2817 S BURRELL ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-2033
Practice Address - Country:US
Practice Address - Phone:414-218-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WINA390200000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program