Individual
DR. JONATHAN A ORTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
403 E 1ST ST, DIXON, IL 61021
(815) 285-5552
(815) 285-5865
Mailing address
403 E 1ST ST, DIXON, IL 61021-3116
(815) 285-5552
(815) 285-5865
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036-077540
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036077540
—
IL
01
—
800200
MEDICARE GROUP PROVIDER NUMBER
IL
01
—
L10167
MEDICARE PTAN
IL
01
—
L53041
MEDICARE PTAN
IL
Enumeration date
03/09/2006
Last updated
11/19/2024
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