Healthcare Provider Details

I. General information

NPI: 1891173373
Provider Name (Legal Business Name): ADAM HENRY HALL ALTMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2015
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4881 SUGAR MAPLE DR
WRIGHT PAT OH
45433-5529
US

IV. Provider business mailing address

15933 CLAYTON RD STE 210
BALLWIN MO
63011-2172
US

V. Phone/Fax

Practice location:
  • Phone: 513-602-0652
  • Fax:
Mailing address:
  • Phone: 513-984-5133
  • Fax: 513-984-4240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD-19012
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: