Healthcare Provider Details

I. General information

NPI: 1417910803
Provider Name (Legal Business Name): RUDOLPH ALAN ALTERGOTT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 WARRENVILLE RD STE. 280
DOWNERS GROVE IL
60515-1748
US

IV. Provider business mailing address

2650 WARRENVILLE RD STE. 280
DOWNERS GROVE IL
60515-1748
US

V. Phone/Fax

Practice location:
  • Phone: 630-324-7915
  • Fax: 630-324-7946
Mailing address:
  • Phone: 630-324-7915
  • Fax: 630-324-7946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036064372
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number1048009
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number1048009
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number036064372
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: