Provider Demographics
NPI:1861508160
Name:HARTMAN, PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:HARTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:ARTHUR
Mailing Address - State:IL
Mailing Address - Zip Code:61911-1269
Mailing Address - Country:US
Mailing Address - Phone:217-543-3444
Mailing Address - Fax:
Practice Address - Street 1:211 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:ARTHUR
Practice Address - State:IL
Practice Address - Zip Code:61911-1269
Practice Address - Country:US
Practice Address - Phone:217-543-3444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-085617207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL35266Medicare PIN