Provider Demographics
NPI:1487193686
Name:MICHAEL A. HARTMAN DPM PC
Entity type:Organization
Organization Name:MICHAEL A. HARTMAN DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:734-455-3669
Mailing Address - Street 1:5226 GREEN RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2718
Mailing Address - Country:US
Mailing Address - Phone:734-455-3669
Mailing Address - Fax:734-455-3797
Practice Address - Street 1:12885 NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-1181
Practice Address - Country:US
Practice Address - Phone:734-283-3777
Practice Address - Fax:734-324-2598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMH001532213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0Q31660OtherMEDICARE PLUS BLUE
MI4279630001OtherNGS ADMINISTAR
MI2634520Medicaid
MI5821404OtherBLUE CROSS
MI0Q31660OtherMEDICARE PLUS BLUE