Provider Demographics
NPI:1497718456
Name:HARTWIG, TIMOTHY D (DO)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:D
Last Name:HARTWIG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 CENTURY MEDICAL DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2100
Mailing Address - Country:US
Mailing Address - Phone:321-268-6264
Mailing Address - Fax:321-268-6273
Practice Address - Street 1:702 COUNTRY CLUB DR
Practice Address - Street 2:PARRISH MEDICAL GROUP
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-4979
Practice Address - Country:US
Practice Address - Phone:321-268-1995
Practice Address - Fax:321-264-0727
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9115207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273076600Medicaid
FLU5293ZMedicare PIN
FLE77444Medicare UPIN