Healthcare Provider Details

I. General information

NPI: 1336593425
Provider Name (Legal Business Name): OLESYA ALTMAN LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2016
Last Update Date: 04/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 E DEVON AVE SUITE 333
DES PLAINES IL
60018-4511
US

IV. Provider business mailing address

1401 BURR OAK RD #317B
HINSDALE IL
60521-2934
US

V. Phone/Fax

Practice location:
  • Phone: 224-803-2273
  • Fax:
Mailing address:
  • Phone: 785-760-2255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164006744
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: