Provider Demographics
NPI:1154302131
Name:HARTENBACH, DAVID E (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:HARTENBACH
Suffix:
Gender:M
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:PO BOX 23340
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63156-3340
Mailing Address - Country:US
Mailing Address - Phone:314-567-7337
Mailing Address - Fax:314-851-4476
Practice Address - Street 1:13001 N OUTER 40 RD STE 320
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5941
Practice Address - Country:US
Practice Address - Phone:314-567-7337
Practice Address - Fax:314-851-4476
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5N56208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO92215275OtherBLUE SHIELD
MO1956V34311OtherHEALTHCARE USA
MO40116OtherGHP
MO4135142OtherAETNA
MO138492OtherHEALTHLINK
MO22999OtherBCBS
MOF07321OtherMERCY
MS1200167OtherUHC
MOF07321Medicare UPIN