Provider Demographics
NPI:1689649055
Name:HARTMAN, RICHARD JOHN JR (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JOHN
Last Name:HARTMAN
Suffix:JR
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 1:410 N WILLOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-9462
Mailing Address - Country:US
Mailing Address - Phone:517-279-9599
Mailing Address - Fax:517-279-1679
Practice Address - Street 1:410 N WILLOWBROOK RD
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-9462
Practice Address - Country:US
Practice Address - Phone:517-279-9599
Practice Address - Fax:517-279-1679
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014488207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3254103OtherCIGNA
MI2051200235OtherBLUE CROSS
MI4011910001OtherMEDICARE DME
MI200039596OtherRAILROAD MEDICARE
MI9507787OtherMULTIPLAN
MI114224404Medicaid
MI73836OtherUHC
09-30215OtherPHP/IBA
MI5093750OtherAETNA
MI114224404Medicaid
MIMI2537001Medicare PIN
MI3254103OtherCIGNA