Healthcare Provider Details

I. General information

NPI: 1154503670
Provider Name (Legal Business Name): MARK ALTCHEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1343 W MAIN ST
MERCED CA
95340-4438
US

IV. Provider business mailing address

7246 REMMET AVE
CANOGA PARK CA
91303-1531
US

V. Phone/Fax

Practice location:
  • Phone: 209-725-1060
  • Fax: 209-725-1064
Mailing address:
  • Phone: 818-206-0360
  • Fax: 818-206-0381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG43919
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: