Provider Demographics
NPI:1669851424
Name:ALTOOS, BASEL MOHAMMAD (MD)
Entity Type:Individual
Prefix:
First Name:BASEL
Middle Name:MOHAMMAD
Last Name:ALTOOS
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:PO BOX 776347
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6347
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:4955 NORTON HEALTHCARE BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2832
Practice Address - Country:US
Practice Address - Phone:502-394-6350
Practice Address - Fax:502-394-6351
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01085991A2085R0001X
COTL0005616390200000X
KY554332085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program