Provider Demographics
NPI:1023096948
Name:HARTMAN, MICHAEL W (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
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 1:1542 TULANE AVE
Mailing Address - Street 2:BOX T6-7
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2865
Mailing Address - Country:US
Mailing Address - Phone:504-568-4680
Mailing Address - Fax:504-568-4466
Practice Address - Street 1:200 W ESPLANADE AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2489
Practice Address - Country:US
Practice Address - Phone:504-412-1700
Practice Address - Fax:504-412-1701
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN44712207X00000X
MO2007022052207XX0005X
LAMD.204132207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205465107Medicaid
MN954693600Medicaid
MN200044359Medicare ID - Type UnspecifiedRAILROAD
MN954693600Medicaid
MO326274838Medicare PIN
H65798Medicare UPIN