Healthcare Provider Details

I. General information

NPI: 1275509457
Provider Name (Legal Business Name): MICHAEL J ADLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 NW NORTHRUP ST STE 600
PORTLAND OR
97209
US

IV. Provider business mailing address

541 NE 20TH AVE STE 225
PORTLAND OR
97232-2895
US

V. Phone/Fax

Practice location:
  • Phone: 503-223-3104
  • Fax: 503-223-4619
Mailing address:
  • Phone: 503-963-2801
  • Fax: 503-963-2825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD18952
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: