Provider Demographics
NPI:1063703759
Name:HARTWIG, KIM MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:MARIE
Last Name:HARTWIG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-2838
Mailing Address - Country:US
Mailing Address - Phone:209-722-9066
Mailing Address - Fax:
Practice Address - Street 1:535 W 25TH ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-2838
Practice Address - Country:US
Practice Address - Phone:209-722-9066
Practice Address - Fax:209-383-1522
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA115659207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FD333ZMedicare PIN