Provider Demographics
NPI:1497816425
Name:ADLER, EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:ADLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2265 LIVERNOIS RD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1633
Mailing Address - Country:US
Mailing Address - Phone:248-362-4440
Mailing Address - Fax:248-362-4552
Practice Address - Street 1:2265 LIVERNOIS RD
Practice Address - Street 2:SUITE 402
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1633
Practice Address - Country:US
Practice Address - Phone:248-362-4440
Practice Address - Fax:248-362-4552
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301033422207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0633817OtherBLUECROSS
MIA75903Medicare UPIN
MI0633817OtherBLUECROSS