Basic Information
Provider Information
NPI: 1568578441
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALTIOK
FirstName: HALUK
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 8500, LOCKBOX 7642
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191787642
CountryCode: US
TelephoneNumber: 8132818115
FaxNumber: 8132818656
Practice Location
Address1: 2211 N. OAK PARK AVENUE
Address2:  
City: CHICAGO
State: IL
PostalCode: 607073392
CountryCode: US
TelephoneNumber: 7733855497
FaxNumber: 7733855488
Other Information
ProviderEnumerationDate: 08/22/2006
LastUpdateDate: 10/25/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/25/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000X036-115377ILY Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 

ID Information
IDTypeStateIssuerDescription
156857844101ILNPIOTHER


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