Provider Demographics
NPI:1942257969
Name:ROBERT D ADAS DPM & LARRY H WEXLER DPM PC
Entity Type:Organization
Organization Name:ROBERT D ADAS DPM & LARRY H WEXLER DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:ADAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-399-5905
Mailing Address - Street 1:26831 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1326
Mailing Address - Country:US
Mailing Address - Phone:248-399-5905
Mailing Address - Fax:248-399-5906
Practice Address - Street 1:26831 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1326
Practice Address - Country:US
Practice Address - Phone:248-399-5905
Practice Address - Fax:248-399-5906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0922213E00000X
MI0940213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1718330Medicaid
MI1718349Medicaid
MI9635046OtherBCBSM ADAS
MI9635045OtherBCBSM WEXLER
MI9635045OtherBCBSM WEXLER
MI9635045Medicare ID - Type UnspecifiedWEXLER
MI1718349Medicaid
MIT34120Medicare UPIN
MI9635046Medicare ID - Type UnspecifiedADAS