Healthcare Provider Details

I. General information

NPI: 1033184528
Provider Name (Legal Business Name): DANIEL C ALTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 W. GOLF RD 206
DES PLAINES IL
60016
US

IV. Provider business mailing address

8901 W. GOLF ROAD 206
DES PLAINES IL
60016-6850
US

V. Phone/Fax

Practice location:
  • Phone: 847-699-0006
  • Fax: 847-699-1744
Mailing address:
  • Phone: 847-699-0006
  • Fax: 847-699-1744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036-092973
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number036092973
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: