Provider Demographics
NPI:1154585115
Name:ALTOROK, NEZAM IBRAHIM
Entity type:Individual
Prefix:DR
First Name:NEZAM
Middle Name:IBRAHIM
Last Name:ALTOROK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NEZAM
Other - Middle Name:IBRAHIM
Other - Last Name:TOROK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3355 GLENDALE AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2426
Mailing Address - Country:US
Mailing Address - Phone:419-383-3780
Mailing Address - Fax:419-383-3269
Practice Address - Street 1:3125 TRANSVERSE DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-8008
Practice Address - Country:US
Practice Address - Phone:419-383-3780
Practice Address - Fax:419-383-3269
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35121127207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35121127OtherOHIO LICENSE