Provider Demographics
NPI:1518183177
Name:HARTMAN, DAVID ELLIOTT (PHD, ABPN ABPP)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ELLIOTT
Last Name:HARTMAN
Suffix:
Gender:M
Credentials:PHD, ABPN ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E ILLINOIS ST STE 320
Mailing Address - Street 2:MEDICAL AND FORENSIC NEUROPSYCHOLOGY
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5302
Mailing Address - Country:US
Mailing Address - Phone:312-527-2772
Mailing Address - Fax:847-433-6782
Practice Address - Street 1:401 E ILLINOIS ST STE 320
Practice Address - Street 2:MEDICAL AND FORENSIC NEUROPSYCHOLOGY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5302
Practice Address - Country:US
Practice Address - Phone:312-527-2772
Practice Address - Fax:847-433-6782
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103G00000X, 103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic