Basic Information
| Provider Information | |||||||||
| NPI: | 1669851424 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALTOOS | ||||||||
| FirstName: | BASEL | ||||||||
| MiddleName: | MOHAMMAD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776347 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 4955 NORTON HEALTHCARE BLVD | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402412832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5023946350 | ||||||||
| FaxNumber: | 5023946351 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2015 | ||||||||
| LastUpdateDate: | 07/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 01085991A | IN | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 390200000X | TL0005616 | CO | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2085R0001X | 55433 | KY | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.