Provider Demographics
NPI:1558754952
Name:ADERMAN, MICHAEL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:ADERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S DAKOTA STATE UNIVERSITY
Mailing Address - Street 2:2820 HPER CENTER
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57007-1497
Mailing Address - Country:US
Mailing Address - Phone:605-688-4003
Mailing Address - Fax:
Practice Address - Street 1:S DAKOTA STATE UNIVERSITY
Practice Address - Street 2:2820 HPER CENTER
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57007-1497
Practice Address - Country:US
Practice Address - Phone:605-688-4003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-09
Last Update Date:2015-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00012592255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0482OtherSDBMOE
2000013908OtherBOC