MEDICARE: CORRINE L. ADLER, DO PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	CA009890	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0858205905	OTHER		BCBS
2	0H24042	OTHER		BCBS

General Provider Information

NPI Number	:	1477768661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORRINE L. ADLER, DO PC

Provider Business Mailing Address
First Line	:	2014 N BEECH DALY
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127
Country	:	US
Telephone Number	:	313-730-1591
Fax Number	:

Provider Business Practice Location Address
First Line	:	2014 N BEECH DALY RD
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-3405
Country	:	US
Telephone Number	:	313-730-1591
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CORRINE LYNN ADLER
Credential	:	D. O.
Telephone Number	:	313-730-1591

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	03/17/2009

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