MEDICARE: DR. EDWARD G ALTMAN PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	071003967	IL

General Provider Information

NPI Number	:	1467461848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD G ALTMAN PSY.D.

Provider Business Mailing Address
First Line	:	7808 W HIGGINS RD APT B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-3345
Country	:	US
Telephone Number	:	773-631-4780
Fax Number	:	773-631-4780

Provider Business Practice Location Address
First Line	:	139 W RAND RD
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-3985
Country	:	US
Telephone Number	:	847-259-8583
Fax Number	:	847-259-8935

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	11/18/2008

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