Provider Demographics
NPI:1336121011
Name:HART, TIMOTHY T (MD)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:T
Last Name:HART
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 1:1301 PENN AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50316-2350
Mailing Address - Country:US
Mailing Address - Phone:515-263-2400
Mailing Address - Fax:515-263-2540
Practice Address - Street 1:1301 PENN AVE
Practice Address - Street 2:STE 100
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-2350
Practice Address - Country:US
Practice Address - Phone:515-263-2400
Practice Address - Fax:515-263-2540
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA25900207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA060029417OtherRR MEDICARE
IA1336121011Medicaid
IACD4547OtherRR GROUP NUMBER
IA0043448Medicaid
IA060029417OtherRR MEDICARE
IA0043448Medicaid
IA1336121011Medicaid