Provider Demographics
NPI:1891844296
Name:HART, DENIS BRIAN (MD)
Entity Type:Individual
Prefix:MR
First Name:DENIS
Middle Name:BRIAN
Last Name:HART
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 1:8265 TRAIL RDG
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MI
Mailing Address - Zip Code:48130-9387
Mailing Address - Country:US
Mailing Address - Phone:734-546-7583
Mailing Address - Fax:
Practice Address - Street 1:8265 TRAIL RDG
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130-9387
Practice Address - Country:US
Practice Address - Phone:734-546-7583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDH038336207N00000X
MI4301038336207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0774600151OtherBLUE CROSS BLUE SHIELD
MI070000253OtherMEDICARE RAILROAD
MI2106573Medicaid
MI0810015OtherBLUE CROSS BLUE SHIELD
MI2106573Medicaid
MI0774600151OtherBLUE CROSS BLUE SHIELD