MEDICARE: DR. PAUL D. OLTMAN 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	207QB0002X	Obesity Medicine (Family Medicine) Physician	036068792	IL
2	207QS0010X	Sports Medicine (Family Medicine) Physician	036068792	IL
3	207Q00000X	Family Medicine Physician	036068792	IL

General Provider Information

NPI Number	:	1942208087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL D. OLTMAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 372
Second Line	:
City	:	MATTOON
State	:	IL
Zip	:	61938-0372
Country	:	US
Telephone Number	:	217-868-2812
Fax Number	:

Provider Business Practice Location Address
First Line	:	905 N MAPLE ST STE D
Second Line	:
City	:	EFFINGHAM
State	:	IL
Zip	:	62401-6401
Country	:	US
Telephone Number	:	217-347-7776
Fax Number	:	217-347-7526

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	05/15/2024

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