Provider Demographics
NPI:1861672891
Name:STUART R. ADLER, MD PC
Entity Type:Organization
Organization Name:STUART R. ADLER, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:R
Authorized Official - Last Name:ADLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:314-355-3175
Mailing Address - Street 1:11155 DUNN RD
Mailing Address - Street 2:SUITE 201E
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-6150
Mailing Address - Country:US
Mailing Address - Phone:314-355-3175
Mailing Address - Fax:314-355-5175
Practice Address - Street 1:11155 DUNN RD
Practice Address - Street 2:SUITE 201E
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6150
Practice Address - Country:US
Practice Address - Phone:314-355-3175
Practice Address - Fax:314-355-5175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1F22207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL242741168Medicaid
MO000015533Medicare PIN
IL242741168Medicaid