Provider Demographics
NPI:1518948066
Name:HARTZ, MATTHEW BRIAN (MD, MPH)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:BRIAN
Last Name:HARTZ
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:M.
Other - Middle Name:BRIAN
Other - Last Name:HARTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:3366 OAKDALE AVE N
Mailing Address - Street 2:STE 605
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-5700
Mailing Address - Country:US
Mailing Address - Phone:763-520-2940
Mailing Address - Fax:763-520-2943
Practice Address - Street 1:3366 OAKDALE AVE N
Practice Address - Street 2:STE 605
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-5700
Practice Address - Country:US
Practice Address - Phone:763-520-2940
Practice Address - Fax:763-520-2943
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33786207RP1001X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAH50993Medicare UPIN