Provider Demographics
NPI:1528032539
Name:HARTGERINK, TODD (DO)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:
Last Name:HARTGERINK
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:PO BOX 2184
Mailing Address - Street 2:CERTIFIED EMERGENCY MEDICINE SPECIALISTS
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49501-2184
Mailing Address - Country:US
Mailing Address - Phone:616-363-7867
Mailing Address - Fax:616-363-9432
Practice Address - Street 1:5900 BYRON CENTER AVE SW
Practice Address - Street 2:METRO HEALTH HOSPITAL
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519
Practice Address - Country:US
Practice Address - Phone:616-252-7123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITH012618207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI930080188OtherRAILDROAD MEDICARE
MITH012618OtherMI PHYSICIANS LICENSE
MI4097277Medicaid
G38019Medicare UPIN