Provider Demographics
NPI:1821083080
Name:ADELMAN, BRUCE TODD (MD)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:TODD
Last Name:ADELMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2799 W GRAND BLVD FL 3
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2608
Mailing Address - Country:US
Mailing Address - Phone:313-916-8078
Mailing Address - Fax:313-916-9867
Practice Address - Street 1:2799 W GRAND BLVD FL 3
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-8078
Practice Address - Fax:313-916-9867
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301043707207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI102652312Medicaid
MI102652312Medicaid
C50939Medicare UPIN