Provider Demographics
NPI:1972686905
Name:DR. BRIAN J. ALTMAN & ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:DR. BRIAN J. ALTMAN & ASSOCIATES, P.C.
Other - Org Name:ALTMAN FOOT & ANKLE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JEFFERY
Authorized Official - Last Name:ALTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:765-962-0521
Mailing Address - Street 1:3923 CHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1085
Mailing Address - Country:US
Mailing Address - Phone:765-962-0521
Mailing Address - Fax:765-962-1610
Practice Address - Street 1:3923 CHESTER BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1085
Practice Address - Country:US
Practice Address - Phone:765-962-0521
Practice Address - Fax:765-962-1610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000953A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2852195Medicaid
INDB9381OtherMEDICARE RAILROAD
IN200387160Medicaid
OH9375021Medicare PIN
IN5250700001Medicare NSC
OH2852195Medicaid