Provider Demographics
NPI:1679611768
Name:ADLER, KENNETH PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:PAUL
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 1:1829 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4344
Mailing Address - Country:US
Mailing Address - Phone:715-836-9218
Mailing Address - Fax:
Practice Address - Street 1:N6500 HAIPEK RD
Practice Address - Street 2:
Practice Address - City:BLACK RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54615-5404
Practice Address - Country:US
Practice Address - Phone:715-284-7371
Practice Address - Fax:715-284-7373
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI29995-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine