Healthcare Provider Details

I. General information

NPI: 1548803315
Provider Name (Legal Business Name): ALTUS DIRECT HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3681 FISHINGER BLVD
HILLIARD OH
43026-9552
US

IV. Provider business mailing address

600 W SANTA ANA BLVD STE 114A3055
SANTA ANA CA
92701-4558
US

V. Phone/Fax

Practice location:
  • Phone: 161-479-5937
  • Fax:
Mailing address:
  • Phone: 614-971-0295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: TAHA SUFYAN SYED
Title or Position: OWNER
Credential:
Phone: 614-971-0295