Provider Demographics
NPI:1235103581
Name:ALTIMARI, ANTHONY F (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:F
Last Name:ALTIMARI
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 1:7 BLANCHARD CIR
Mailing Address - Street 2:STE 104
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-2037
Mailing Address - Country:US
Mailing Address - Phone:630-668-0833
Mailing Address - Fax:630-668-7685
Practice Address - Street 1:7 BLANCHARD CIR
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-2037
Practice Address - Country:US
Practice Address - Phone:630-668-0833
Practice Address - Fax:630-668-7685
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036070901208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036070901OtherMEDICAID
IL206147OtherMEDICARE (GROUP PTAN)
ILCA4748OtherMEDICARE RAILROAD (GROUP)
IL206147263OtherMEDICARE (INDIVIDUAL PTAN)
ILP01245137OtherMEDICARE RAILROAD (PROVIDER)
IL036070901OtherMEDICAID