Provider Demographics
NPI:1760414502
Name:ADLER, MILES FRANKLIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MILES
Middle Name:FRANKLIN
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 1:13847 E 14TH ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2632
Mailing Address - Country:US
Mailing Address - Phone:510-357-8180
Mailing Address - Fax:510-357-0276
Practice Address - Street 1:13847 E 14TH ST
Practice Address - Street 2:SUITE 115
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2632
Practice Address - Country:US
Practice Address - Phone:510-357-8180
Practice Address - Fax:510-357-0276
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG16859207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA39933Medicare UPIN
CAG16959Medicare ID - Type UnspecifiedMEDICAL LICENSE