Provider Demographics
NPI:1306069497
Name:CORRINE L. ADLER ,D.O., P.C
Entity type:Organization
Organization Name:CORRINE L. ADLER ,D.O., P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORRINE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ADLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-730-1591
Mailing Address - Street 1:2014 BEECH DALY RD.
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48146
Mailing Address - Country:US
Mailing Address - Phone:313-730-1634
Mailing Address - Fax:
Practice Address - Street 1:2014 BEECH DALY RD.
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48146
Practice Address - Country:US
Practice Address - Phone:313-730-1634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICA009890261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3524148 TYPE 11Medicaid
MIF03695Medicare UPIN