Healthcare Provider Details

I. General information

NPI: 1609849991
Provider Name (Legal Business Name): STEPHEN C ALTMIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11600 W 2ND PL
LAKEWOOD CO
80228-1527
US

IV. Provider business mailing address

4535 DRESSLER RD NW
CANTON OH
44718-2545
US

V. Phone/Fax

Practice location:
  • Phone: 720-321-4161
  • Fax: 720-321-4165
Mailing address:
  • Phone: 330-492-4559
  • Fax: 330-451-4035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number39829
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: