MEDICARE: MICHAEL ALT DO

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	2084N0400X	Neurology Physician	02245	KY

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

General Provider Information

NPI Number	:	1740227255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL ALT DO

Provider Business Mailing Address
First Line	:	2934 BRECKENRIDGE LN STE 2
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40220-3903
Country	:	US
Telephone Number	:	502-454-7871
Fax Number	:	502-454-7872

Provider Business Practice Location Address
First Line	:	2934 BRECKENRIDGE LN STE 2
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40220-3903
Country	:	US
Telephone Number	:	502-454-7871
Fax Number	:	502-454-7872

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

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	04/17/2014

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Directions to “ MICHAEL ALT DO” Practice Location

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