=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033293659
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MATTHEW F ADLER PA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2006
-----------------------------------------------------
Last Update Date | 10/11/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2300 GENOA BUSINESS PARK DR SUITE 220
-----------------------------------------------------
City | BRIGHTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48114-7367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-220-4422
-----------------------------------------------------
Fax | 810-225-4696
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6888 GRAND RIVER AVE
-----------------------------------------------------
City | BRIGHTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48114-9345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-220-4422
-----------------------------------------------------
Fax | 810-220-1123
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 561003547
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------