Provider Demographics
NPI:1649276916
Name:ADLER, MITCHELL A (MD)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:A
Last Name:ADLER
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 1:17262 COPPER VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-9279
Mailing Address - Country:US
Mailing Address - Phone:805-705-0495
Mailing Address - Fax:
Practice Address - Street 1:4567 E 9TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3908
Practice Address - Country:US
Practice Address - Phone:303-320-2484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0066994207V00000X
CAG72287207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODR.0066994Medicaid
CA00G722870Medicaid
CAF92470Medicare UPIN