Provider Demographics
NPI:1174503619
Name:HART, JOHN KEVIN (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KEVIN
Last Name:HART
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:PO BOX 497
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:IA
Mailing Address - Zip Code:52641-0497
Mailing Address - Country:US
Mailing Address - Phone:319-385-1128
Mailing Address - Fax:319-385-1129
Practice Address - Street 1:209 S WHITE ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:IA
Practice Address - Zip Code:52641-2157
Practice Address - Country:US
Practice Address - Phone:319-385-1128
Practice Address - Fax:319-385-1129
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00535213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA41870OtherBLUE CROSS
IA2101345Medicaid
IAU36862Medicare UPIN
IA3894960001Medicare NSC
IA2101345Medicaid