Basic Information
| Provider Information | |||||||||
| NPI: | 1497191548 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALTENBURG | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | KELLY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 MANNING DRIVE, 2107 OLD CLINIC , CB# 7510 | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199662992 | ||||||||
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| Practice Location | |||||||||
| Address1: | ACC CLINIC | ||||||||
| Address2: | 102 MASON FARM ROAD | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275990001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199661459 | ||||||||
| FaxNumber: | 9198439355 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2013 | ||||||||
| LastUpdateDate: | 03/08/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085N0700X | 2016-02574 | NC | Y | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology |
No ID Information.