Provider Demographics
NPI:1508805151
Name:ADLER, KENNETH G (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:G
Last Name:ADLER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:5055 E BROADWAY BLVD
Mailing Address - Street 2:STE A-100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3640
Mailing Address - Country:US
Mailing Address - Phone:520-327-0460
Mailing Address - Fax:520-795-0225
Practice Address - Street 1:5300 E ERICKSON DR
Practice Address - Street 2:STE 108
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2828
Practice Address - Country:US
Practice Address - Phone:520-721-5330
Practice Address - Fax:520-547-5743
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2020-11-13
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Provider Licenses
StateLicense IDTaxonomies
AZ18485207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D50134Medicare UPIN