MEDICARE: DR. BRIAN JEFFERY ALTMAN DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	PO3818	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386727303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN JEFFERY ALTMAN DPM

Provider Business Mailing Address
First Line	:	18251 MERCHANTS AVE
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33948-2300
Country	:	US
Telephone Number	:	815-517-5981
Fax Number	:

Provider Business Practice Location Address
First Line	:	3923 CHESTER BLVD
Second Line	:
City	:	RICHMOND
State	:	IN
Zip	:	47374-1085
Country	:	US
Telephone Number	:	765-962-0521
Fax Number	:	765-962-1610

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	12/18/2017

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