Healthcare Provider Details

I. General information

NPI: 1083473003
Provider Name (Legal Business Name): ADLER DAVID HENN ATS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 S BURRELL ST
MILWAUKEE WI
53207-2033
US

IV. Provider business mailing address

2817 S BURRELL ST
MILWAUKEE WI
53207-2033
US

V. Phone/Fax

Practice location:
  • Phone: 414-218-9111
  • Fax:
Mailing address:
  • Phone: 414-218-9111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberNA
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: