Healthcare Provider Details

I. General information

NPI: 1851341119
Provider Name (Legal Business Name): MARK DAVID ADLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 04/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE # 62
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

225 E CHICAGO AVE # 62
CHICAGO IL
60611-2991
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-6080
  • Fax:
Mailing address:
  • Phone: 312-227-6080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number036104930
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: