Provider Demographics
NPI:1376598516
Name:HARTSTEIN, MICHAEL P (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:HARTSTEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2550 NORTH HOLLYWOOD WAY
Mailing Address - Street 2:SUITE 209
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-5019
Mailing Address - Country:US
Mailing Address - Phone:818-557-0135
Mailing Address - Fax:818-557-1394
Practice Address - Street 1:41870 GARSTIN DRIVE
Practice Address - Street 2:
Practice Address - City:BIG BEAR LAKE
Practice Address - State:CA
Practice Address - Zip Code:92315-1649
Practice Address - Country:US
Practice Address - Phone:909-878-8201
Practice Address - Fax:909-878-8286
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A62973207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX62970Medicaid
CA20A6297OtherBLUE CROSS
CA00AX62970OtherCALOPTIMA
CA020A62970OtherBLUE SHIELD
CA050618CF57798OtherBEAR VALLEY TRAILBLAZER
CA20A6297OtherBLUE CROSS
CA050618CF57798OtherBEAR VALLEY TRAILBLAZER
CAF57798Medicare UPIN