Provider Demographics
NPI:1083922090
Name:PAUL D. OLTMAN, M.D., S.C.
Entity Type:Organization
Organization Name:PAUL D. OLTMAN, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:OLTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-347-7776
Mailing Address - Street 1:900 W TEMPLE AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-2121
Mailing Address - Country:US
Mailing Address - Phone:217-347-7776
Mailing Address - Fax:217-347-7526
Practice Address - Street 1:900 W TEMPLE AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2121
Practice Address - Country:US
Practice Address - Phone:217-347-7776
Practice Address - Fax:217-347-7526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068792207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC48697Medicare UPIN