Provider Demographics
NPI:1659468296
Name:ADELSON, IRWIN (MD)
Entity type:Individual
Prefix:
First Name:IRWIN
Middle Name:
Last Name:ADELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25401 TWEED DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48025-2317
Mailing Address - Country:US
Mailing Address - Phone:248-626-5388
Mailing Address - Fax:
Practice Address - Street 1:25401 TWEED DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MI
Practice Address - Zip Code:48025-2317
Practice Address - Country:US
Practice Address - Phone:248-626-5388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010253352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4817458Medicaid
N26360023Medicare ID - Type Unspecified
B43104Medicare UPIN
MI0630046Medicare ID - Type Unspecified