Provider Demographics
NPI:1295728202
Name:ADELMAN, MARC H (DO)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:H
Last Name:ADELMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 EAST LONG LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085
Mailing Address - Country:US
Mailing Address - Phone:248-643-7520
Mailing Address - Fax:248-813-6511
Practice Address - Street 1:4550 INVESTMENT DR
Practice Address - Street 2:SUITE 200
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098
Practice Address - Country:US
Practice Address - Phone:248-643-7520
Practice Address - Fax:248-519-6004
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMA007155207V00000X
MI5101007155207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI112914953Medicaid
MI5630628Medicare PIN
MI112914953Medicaid