Provider Demographics
NPI:1508030032
Name:MICHAEL ALT DO PSC
Entity Type:Organization
Organization Name:MICHAEL ALT DO PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-897-5997
Mailing Address - Street 1:2934 BRECKENRIDGE LN STE 2
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-3903
Mailing Address - Country:US
Mailing Address - Phone:502-454-7871
Mailing Address - Fax:502-454-7872
Practice Address - Street 1:2934 BRECKENRIDGE LN STE 2
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-3903
Practice Address - Country:US
Practice Address - Phone:502-454-7871
Practice Address - Fax:502-454-7872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64022452Medicaid
KY50018842OtherPASSPORT
KY00641Medicare PIN