Provider Demographics
NPI:1417910803
Name:ALTERGOTT, RUDOLPH ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RUDOLPH
Middle Name:ALAN
Last Name:ALTERGOTT
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 1:2650 WARRENVILLE RD
Mailing Address - Street 2:STE. 280
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1748
Mailing Address - Country:US
Mailing Address - Phone:630-324-7915
Mailing Address - Fax:630-324-7946
Practice Address - Street 1:2650 WARRENVILLE RD
Practice Address - Street 2:STE. 280
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1748
Practice Address - Country:US
Practice Address - Phone:630-324-7915
Practice Address - Fax:630-324-7946
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036064372208600000X, 208G00000X
IN1048009208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
526620OtherCOOK GROUP
IL36064372Medicaid
394390OtherDUPAGE GROUP
IN877470Medicare ID - Type Unspecified
ILL31194Medicare ID - Type Unspecified
IL36064372Medicaid
394390OtherDUPAGE GROUP
526620OtherCOOK GROUP