Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 036.149863 | IL |
N | 2084N0402X | Child Neurologist | R8D55 | MO |
NPI | 1043252521 |
---|---|
Provider Name | Dr. Denis Ian Altman |
First Address | Saint Louis, MO 63141-8232 |
Second Address | Chicago, IL 60611-2991 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2006 |
Last Update Date | 08/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E58605 | (02) |