Provider Demographics
NPI:1548547243
Name:COTTER, ADOLFO (MD)
Entity type:Individual
Prefix:DR
First Name:ADOLFO
Middle Name:
Last Name:COTTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 EAST LIBERTY LOWER LEVEL
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-1187
Mailing Address - Country:US
Mailing Address - Phone:734-780-6029
Mailing Address - Fax:416-800-8762
Practice Address - Street 1:330 E LIBERTY ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2274
Practice Address - Country:US
Practice Address - Phone:734-780-6029
Practice Address - Fax:416-800-8762
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01070384A208D00000X
MI4301098929208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FC3484502OtherDEA