Provider Demographics
NPI:1992831911
Name:ADLER, DONALD (DPM)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:ADLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9321 JOSEPH CAMPAU ST
Mailing Address - Street 2:
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-3433
Mailing Address - Country:US
Mailing Address - Phone:313-871-8228
Mailing Address - Fax:313-871-0022
Practice Address - Street 1:9321 JOSEPH CAMPAU ST
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-3433
Practice Address - Country:US
Practice Address - Phone:313-871-8228
Practice Address - Fax:313-871-0022
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000935213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI131339552Medicaid
MIU21496Medicare UPIN
MI8825024Medicare PIN