1679681175 NPI number — DR. IRMA LETICIA ALTAMIRANO DPM

Table of content: DR. IRMA LETICIA ALTAMIRANO DPM (NPI 1679681175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679681175 NPI number — DR. IRMA LETICIA ALTAMIRANO DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALTAMIRANO
Provider First Name:
IRMA
Provider Middle Name:
LETICIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALTAMIRANO
Provider Other First Name:
IRMA
Provider Other Middle Name:
LETICIA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPM
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1679681175
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 PHYSICIANS PARK
Provider Second Line Business Mailing Address:
#3
Provider Business Mailing Address City Name:
FRANKFORT
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40601-4163
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-227-7569
Provider Business Mailing Address Fax Number:
502-227-4442

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 PHYSICIANS PARK
Provider Second Line Business Practice Location Address:
#3
Provider Business Practice Location Address City Name:
FRANKFORT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40601-4163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-227-7569
Provider Business Practice Location Address Fax Number:
502-227-4442
Provider Enumeration Date:
08/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  257 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 80000359 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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