Provider Demographics
NPI:1679681175
Name:ALTAMIRANO, IRMA LETICIA (DPM)
Entity Type:Individual
Prefix:DR
First Name:IRMA
Middle Name:LETICIA
Last Name:ALTAMIRANO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:IRMA
Other - Middle Name:LETICIA
Other - Last Name:ALTAMIRANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:5 PHYSICIANS PARK
Mailing Address - Street 2:#3
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-4163
Mailing Address - Country:US
Mailing Address - Phone:502-227-7569
Mailing Address - Fax:502-227-4442
Practice Address - Street 1:5 PHYSICIANS PARK
Practice Address - Street 2:#3
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4163
Practice Address - Country:US
Practice Address - Phone:502-227-7569
Practice Address - Fax:502-227-4442
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY257213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY80000359Medicaid
0659602Medicare ID - Type Unspecified
KY80000359Medicaid