=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477768661
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORRINE L. ADLER, DO PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2007
-----------------------------------------------------
Last Update Date | 03/17/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2014 N BEECH DALY RD
-----------------------------------------------------
City | DEARBORN HEIGHTS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48127-3405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-730-1591
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2014 N BEECH DALY
-----------------------------------------------------
City | DEARBORN HEIGHTS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-730-1591
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | CORRINE LYNN ADLER
-----------------------------------------------------
Credential | D. O.
-----------------------------------------------------
Telephone | 313-730-1591
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | CA009890
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------