Provider Demographics
NPI:1134166648
Name:HARTZ, RENEE S (MD)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:S
Last Name:HARTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 BALDWIN LN
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-4445
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:708-386-5547
Practice Address - Street 1:6304 N NAGLE AVE STE 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646
Practice Address - Country:US
Practice Address - Phone:773-628-7654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036051428208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1697141Medicaid
LA5Y553CP86Medicare ID - Type Unspecified
LAD89299Medicare UPIN