Basic Information
| Provider Information | |||||||||
| NPI: | 1780645564 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADLER | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 3999 DUTCHMANS LN STE 7B | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028964711 | ||||||||
| FaxNumber: | 5028964791 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2006 | ||||||||
| LastUpdateDate: | 08/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 21649 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 208600000X | 21649 | KY | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 64216492 | 05 | KY | MEDICAID | 000000049917 | 01 | KY | ANTHEM PIN # | OTHER | P01034888 | 01 | KY | RAILROAD MEDICARE | OTHER | 201048670 | 05 | IN | MEDICAID | 50034543 | 01 | KY | PASSPORT | OTHER |