Provider Demographics
NPI:1053471946
Name:ALTMAN, RONALD F (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:F
Last Name:ALTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 N DEERE PARK DR E
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-5349
Mailing Address - Country:US
Mailing Address - Phone:847-433-1217
Mailing Address - Fax:
Practice Address - Street 1:361 N DEERE PARK DR E
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-5349
Practice Address - Country:US
Practice Address - Phone:847-433-1217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036056297208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL637450Medicare ID - Type Unspecified
C43275Medicare UPIN