Healthcare Provider Details

I. General information

NPI: 1063659928
Provider Name (Legal Business Name): IGOR ALTMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2009
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 S WOOD ST # MC958 UIMC -- VASCULAR SURGERY DIVISION
CHICAGO IL
60612-4325
US

IV. Provider business mailing address

840 S WOOD ST # MC958 UIMC -- VASCULAR SURGERY DIVISION, SUITE 376N
CHICAGO IL
60612-4325
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-8459
  • Fax: 312-355-3722
Mailing address:
  • Phone: 312-996-8459
  • Fax: 312-355-3722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOT012311
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.126214
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS014690
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: