Provider Demographics
NPI:1083661128
Name:DR MARVIN ADLER DPM PC
Entity type:Organization
Organization Name:DR MARVIN ADLER DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:ADLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:313-871-8228
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDA000935213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5873290001Medicare NSC
5825002Medicare PIN