Provider Demographics
NPI:1124088075
Name:ADELSON, TODD ANDREW (DO)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:ANDREW
Last Name:ADELSON
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 1:40053 8 MILE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1954
Mailing Address - Country:US
Mailing Address - Phone:248-449-9292
Mailing Address - Fax:248-449-1081
Practice Address - Street 1:40053 8 MILE RD STE 100
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1954
Practice Address - Country:US
Practice Address - Phone:248-449-9292
Practice Address - Fax:248-449-1081
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015034207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MII26016Medicare UPIN
MIP10750002Medicare ID - Type UnspecifiedMEDICARE