Provider Demographics
NPI:1417119033
Name:IRWIN P. ADELSON, M.D., P.C.
Entity Type:Organization
Organization Name:IRWIN P. ADELSON, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRWIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:ADELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-626-5388
Mailing Address - Street 1:25401 TWEED DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48025-2317
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25401 TWEED DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MI
Practice Address - Zip Code:48025-2317
Practice Address - Country:US
Practice Address - Phone:248-626-5388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010253352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4817458Medicaid
0630046OtherBCBSM
0630046OtherBCBSM
MIB43104Medicare UPIN
MI4817458Medicaid