MEDICARE: KATHLEEN A. ALTER M.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	207R00000X	Internal Medicine Physician	35-05-0765	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780618413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN A. ALTER M.D.

Provider Business Mailing Address
First Line	:	2960 MACK RD
Second Line	:	SUITE 210
City	:	FAIRFIELD
State	:	OH
Zip	:	45014-5373
Country	:	US
Telephone Number	:	513-860-2777
Fax Number	:	513-860-9507

Provider Business Practice Location Address
First Line	:	2960 MACK RD
Second Line	:	SUITE 210
City	:	FAIRFIELD
State	:	OH
Zip	:	45014-5373
Country	:	US
Telephone Number	:	513-860-2777
Fax Number	:	513-860-9507

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	02/13/2008

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