Provider Demographics
NPI:1609849991
Name:ALTMIN, STEPHEN C (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:C
Last Name:ALTMIN
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 1:4535 DRESSLER RD NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2545
Mailing Address - Country:US
Mailing Address - Phone:330-492-4559
Mailing Address - Fax:330-451-4035
Practice Address - Street 1:11600 W 2ND PL
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1527
Practice Address - Country:US
Practice Address - Phone:720-321-4161
Practice Address - Fax:720-321-4165
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39829207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
20326023101OtherPACIFICARE SECURE HORIZONS
CO76275329Medicaid
COP00334740OtherRR MEDICARE
NEPENDINGMedicaid
UTZ3293Medicaid
KS200389960AMedicaid
WY122680100Medicaid
AZ128190Medicaid
COH63907Medicare UPIN
KS200389960AMedicaid