Provider Demographics
NPI:1326604653
Name:HARDMAN MEDICAL PLLC
Entity Type:Organization
Organization Name:HARDMAN MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:EL MASRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-215-0048
Mailing Address - Street 1:50 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COOPERSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49404-1231
Mailing Address - Country:US
Mailing Address - Phone:616-997-4023
Mailing Address - Fax:616-997-4025
Practice Address - Street 1:50 MAIN ST
Practice Address - Street 2:
Practice Address - City:COOPERSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49404-1231
Practice Address - Country:US
Practice Address - Phone:616-997-4023
Practice Address - Fax:616-997-4025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty