Provider Demographics
NPI:1679636690
Name:ALTMAN, DAVID BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BRUCE
Last Name:ALTMAN
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 1:9933 LAWLER AVE STE 444
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-3707
Mailing Address - Country:US
Mailing Address - Phone:847-674-2025
Mailing Address - Fax:847-674-2073
Practice Address - Street 1:9933 LAWLER AVE STE 444
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3707
Practice Address - Country:US
Practice Address - Phone:847-674-2025
Practice Address - Fax:847-674-2073
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360471572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036047157Medicaid
IL658950Medicare ID - Type UnspecifiedIL MEDICARE PROVIDER NUMB
IL036047157Medicaid