Healthcare Provider Details

I. General information

NPI: 1598025546
Provider Name (Legal Business Name): PERRY ROSS ALTMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17877 W 14 MILE RD
BEVERLY HILLS MI
48025-3127
US

IV. Provider business mailing address

26901 BEAUMONT BLVD STE 3D
SOUTHFIELD MI
48033-3849
US

V. Phone/Fax

Practice location:
  • Phone: 248-644-3920
  • Fax: 248-644-2569
Mailing address:
  • Phone: 947-522-1863
  • Fax: 947-522-0307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301100587
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number4301100587
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number4301100587
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: