Provider Demographics
NPI:1821203720
Name:HOWARD L. ALT, MD, SC
Entity Type:Organization
Organization Name:HOWARD L. ALT, MD, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:LANG
Authorized Official - Last Name:ALT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-642-0060
Mailing Address - Street 1:645 N MICHIGAN AVE STE 422
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5800
Mailing Address - Country:US
Mailing Address - Phone:312-642-0060
Mailing Address - Fax:312-642-1403
Practice Address - Street 1:645 N MICHIGAN AVE STE 422
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5800
Practice Address - Country:US
Practice Address - Phone:312-642-0060
Practice Address - Fax:312-642-1403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2008-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-45795305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL476280Medicare ID - Type UnspecifiedMEDICARE NUMBER
IL476280Medicare UPIN