Basic Information
| Provider Information | |||||||||
| NPI: | 1386645828 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADLER | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 LAUREL AVE # N304 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379161810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8657666870 | ||||||||
| FaxNumber: | 8657660133 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 LAUREL AVE # N304 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379161810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8657666870 | ||||||||
| FaxNumber: | 8657660133 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 07/23/2015 | ||||||||
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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 | 2085R0202X | 37603 | TN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 64071525 | 05 | KY | MEDICAID | RO7104 | 01 | TN | JOHN DEERE | OTHER | 4064904 | 01 | TN | BCBS | OTHER | 266808 | 01 | VA | ANTHEM BCBS | OTHER | P00010086 | 01 | PGBA (RR MEDICARE) | OTHER | 3001446 | 05 | TN | MEDICAID | 010035601 | 05 | VA | MEDICAID |