Healthcare Provider Details

I. General information

NPI: 1992777106
Provider Name (Legal Business Name): MICHAEL S ALTMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 E PALM LN SUITE A260
PHOENIX AZ
85004-4603
US

IV. Provider business mailing address

PO BOX 27340
PHOENIX AZ
85061-7340
US

V. Phone/Fax

Practice location:
  • Phone: 602-266-1718
  • Fax: 602-279-1720
Mailing address:
  • Phone: 602-943-9200
  • Fax: 602-216-3000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number6248
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: