Provider Demographics
NPI:1326308925
Name:KAREN ALTAY MD LTD
Entity Type:Organization
Organization Name:KAREN ALTAY MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALTAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-893-0900
Mailing Address - Street 1:471 W ARMY TRAIL RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2673
Mailing Address - Country:US
Mailing Address - Phone:630-893-0900
Mailing Address - Fax:630-893-0922
Practice Address - Street 1:471 W ARMY TRAIL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2673
Practice Address - Country:US
Practice Address - Phone:630-893-0900
Practice Address - Fax:630-893-0922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.061735174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD16654OtherMEDICARE PTAN 783880
ILD16654Medicare UPIN