Provider Demographics
NPI:1184658676
Name:HARTMAN, MICHAEL S (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:HARTMAN
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 100
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75461-0100
Mailing Address - Country:US
Mailing Address - Phone:903-785-6029
Mailing Address - Fax:903-785-5421
Practice Address - Street 1:3015 NE LOOP 286
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460
Practice Address - Country:US
Practice Address - Phone:903-785-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL10672085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
047324110OtherAMERIGROUP
TX047324110Medicaid
047324111OtherAMERIGROUP
TX047324108Medicaid
TX047324112Medicaid
TX047324109Medicaid
OK20027100AMedicaid
047324108OtherAMERIGROUP
047324109OtherAMERIGROUP
TX047324111Medicaid
TX047324109Medicaid
047324108OtherAMERIGROUP
047324111OtherAMERIGROUP
TX8B8653Medicare ID - Type Unspecified
TX8B8651Medicare ID - Type Unspecified
TX047324112Medicaid
TX047324108Medicaid
AR159058001Medicare ID - Type Unspecified
TX047324110Medicaid