Provider Demographics
NPI:1487870176
Name:ALTMAN-STEELE, KENNETH SCOTT (DPM)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:SCOTT
Last Name:ALTMAN-STEELE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 STANLEY ST
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-2810
Mailing Address - Country:US
Mailing Address - Phone:415-378-3305
Mailing Address - Fax:866-305-3882
Practice Address - Street 1:116 STANLEY ST
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-2810
Practice Address - Country:US
Practice Address - Phone:415-378-3305
Practice Address - Fax:866-305-3882
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4203213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU76866Medicare UPIN