Provider Demographics
NPI:1477660413
Name:HARTKER, FREDERICK (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:
Last Name:HARTKER
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 400
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32902
Mailing Address - Country:US
Mailing Address - Phone:954-698-9399
Mailing Address - Fax:954-698-6963
Practice Address - Street 1:1315 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806
Practice Address - Country:US
Practice Address - Phone:407-999-9977
Practice Address - Fax:321-309-9033
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ414372085N0700X
FLME00912572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271038200Medicaid
FL52136WMedicare ID - Type Unspecified
FL271038200Medicaid