Provider Demographics
NPI:1952083222
Name:ALTEA, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:ALTEA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4318 SQUIRREL RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-3062
Mailing Address - Country:US
Mailing Address - Phone:248-712-4275
Mailing Address - Fax:248-792-3985
Practice Address - Street 1:4318 SQUIRREL RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-3062
Practice Address - Country:US
Practice Address - Phone:248-712-4275
Practice Address - Fax:248-792-3985
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-04
Last Update Date:2023-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704298826163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse