Provider Demographics
NPI:1639758030
Name:ALTMAN, ALEXANDER MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:MICHAEL
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 1:1600 E RIVERVIEW AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:NAPOLEON
Mailing Address - State:OH
Mailing Address - Zip Code:43545-9806
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 E RIVERVIEW AVE STE 101
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-9806
Practice Address - Country:US
Practice Address - Phone:419-592-8774
Practice Address - Fax:419-592-4103
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.150937207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine