Healthcare Provider Details

I. General information

NPI: 1881616308
Provider Name (Legal Business Name): NOLAN ALTMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62ND AVE RADIOLOGY DEPARTMENT
MIAMI FL
33155
US

IV. Provider business mailing address

PO BOX 557367
MIAMI FL
33255-7367
US

V. Phone/Fax

Practice location:
  • Phone: 305-662-8293
  • Fax: 305-667-8689
Mailing address:
  • Phone: 305-662-8293
  • Fax: 305-667-8689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberME42882
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME42882
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: