Provider Demographics
NPI:1467461848
Name:ALTMAN, EDWARD G (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:G
Last Name:ALTMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7808 W HIGGINS RD APT B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3345
Mailing Address - Country:US
Mailing Address - Phone:773-631-4780
Mailing Address - Fax:773-631-4780
Practice Address - Street 1:139 W RAND RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-3985
Practice Address - Country:US
Practice Address - Phone:847-259-8583
Practice Address - Fax:847-259-8935
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071003967103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL205651Medicare ID - Type Unspecified