Provider Demographics
NPI:1861509283
Name:HARTIG, KEVIN S (BC/HIS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:S
Last Name:HARTIG
Suffix:
Gender:M
Credentials:BC/HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 CHARNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-2206
Mailing Address - Country:US
Mailing Address - Phone:248-828-7718
Mailing Address - Fax:
Practice Address - Street 1:43184 DEQUINDRE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1709
Practice Address - Country:US
Practice Address - Phone:586-991-0450
Practice Address - Fax:586-991-0630
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies