Healthcare Provider Details

I. General information

NPI: 1821021429
Provider Name (Legal Business Name): ARTHUR MARK ALTBUCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

849 KELLOGG AVE
JANESVILLE WI
53546-2808
US

IV. Provider business mailing address

849 KELLOGG AVE
JANESVILLE WI
53546-2808
US

V. Phone/Fax

Practice location:
  • Phone: 608-755-7960
  • Fax:
Mailing address:
  • Phone: 608-755-7960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number41950
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number41950
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number41950
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30494
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number30493
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number30494
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: