Provider Demographics
NPI:1689692196
Name:HARTMAN, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:HARTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1824 DORCHESTER CT STE A
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-6819
Mailing Address - Country:US
Mailing Address - Phone:574-534-2548
Mailing Address - Fax:574-534-3622
Practice Address - Street 1:525 OAK CENTRE DR STE 140
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3916
Practice Address - Country:US
Practice Address - Phone:210-504-3650
Practice Address - Fax:210-519-3045
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN010508151A207X00000X, 207XS0117X
TXU1913207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000600321OtherANTHEM BCBS
IN000000600321OtherANTHEM BCBS
IN261250AMedicare PIN