Provider Demographics
NPI:1992041446
Name:CENTER FOR DIGESTIVE CARE LLC
Entity type:Organization
Organization Name:CENTER FOR DIGESTIVE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-434-6262
Mailing Address - Street 1:5300 ELLIOTT DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-8632
Mailing Address - Country:US
Mailing Address - Phone:734-434-6273
Mailing Address - Fax:734-434-1942
Practice Address - Street 1:5300 ELLIOTT DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-8632
Practice Address - Country:US
Practice Address - Phone:734-434-6273
Practice Address - Fax:734-434-1942
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR DIGESTIVE CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-02
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP11690053Medicare PIN
MIP11690020Medicare PIN
MIP11690023Medicare PIN
MIP11690025Medicare PIN
MIP11690005Medicare PIN
MIP11690016Medicare PIN
MIP11690024Medicare PIN
MIP11690027Medicare PIN
MIP11690029Medicare PIN
MIP11690002Medicare PIN
MI0P11690Medicare PIN
MIP11690013Medicare PIN
MIP11690019Medicare PIN
MIP11690022Medicare PIN
MIP11690026Medicare PIN
MIP11690028Medicare PIN
MIP11690010Medicare PIN
MIP11690014Medicare PIN
MIP11690012Medicare PIN
MIP11690015Medicare PIN
MIP11690018Medicare PIN
MIP11690030Medicare PIN
MIP11690031Medicare PIN