Healthcare Provider Details

I. General information

NPI: 1992041446
Provider Name (Legal Business Name): CENTER FOR DIGESTIVE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2013
Last Update Date: 10/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 ELLIOTT DR
YPSILANTI MI
48197-8632
US

IV. Provider business mailing address

5300 ELLIOTT DR
YPSILANTI MI
48197-8632
US

V. Phone/Fax

Practice location:
  • Phone: 734-434-6273
  • Fax: 734-434-1942
Mailing address:
  • Phone: 734-434-6273
  • Fax: 734-434-1942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: DR. LARRY A ADLER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 734-434-6262