Basic Information
| Provider Information | |||||||||
| NPI: | 1033293659 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADLER | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6888 GRAND RIVER AVE | ||||||||
| Address2: | |||||||||
| City: | BRIGHTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481149345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102204422 | ||||||||
| FaxNumber: | 8102201123 | ||||||||
| Practice Location | |||||||||
| Address1: | 2300 GENOA BUSINESS PARK DR | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | BRIGHTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481147367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102204422 | ||||||||
| FaxNumber: | 8102254696 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 10/11/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 561003547 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.