Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 036056297 | IL |
NPI | 1053471946 |
---|---|
Provider Name | Ronald F Altman |
First Address | Highland Park, IL 60035-5349 |
Second Address | Highland Park, IL 60035-5349 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 22/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C43275 | (02) |