Provider Demographics
NPI:1740227255
Name:ALT, MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:ALT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2934 BRECKENRIDGE LN STE 2
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-3903
Mailing Address - Country:US
Mailing Address - Phone:502-454-7871
Mailing Address - Fax:502-454-7872
Practice Address - Street 1:2934 BRECKENRIDGE LN STE 2
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-3903
Practice Address - Country:US
Practice Address - Phone:502-454-7871
Practice Address - Fax:502-454-7872
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY022452084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64022452Medicaid
KY0725701Medicare PIN
F25589Medicare UPIN