Provider Demographics
NPI:1518097120
Name:ALTAY, KAREN A (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:ALTAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 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
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-061735207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL783880Medicare ID - Type Unspecified
ILD-16654Medicare UPIN