Provider Demographics
NPI:1477768661
Name:CORRINE L. ADLER, DO PC
Entity Type:Organization
Organization Name:CORRINE L. ADLER, DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CORRINE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ADLER
Authorized Official - Suffix:
Authorized Official - Credentials:D O
Authorized Official - Phone:313-730-1591
Mailing Address - Street 1:2014 N BEECH DALY
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127
Mailing Address - Country:US
Mailing Address - Phone:313-730-1591
Mailing Address - Fax:
Practice Address - Street 1:2014 N BEECH DALY RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-3405
Practice Address - Country:US
Practice Address - Phone:313-730-1591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICA009890208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0858205905OtherBCBS
0H24042OtherBCBS
MIF03695Medicare UPIN
0M76390Medicare PIN