Provider Demographics
NPI:1336158567
Name:HARTWICK, FRANK M (MD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:M
Last Name:HARTWICK
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:PO BOX 15498
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95857
Mailing Address - Country:US
Mailing Address - Phone:559-455-4000
Mailing Address - Fax:559-455-4007
Practice Address - Street 1:1121 W VINE STREET
Practice Address - Street 2:SUITE 15
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240
Practice Address - Country:US
Practice Address - Phone:209-334-4416
Practice Address - Fax:209-371-0119
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG488862085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1336158567Medicaid
CA00G488860Medicaid
CA00G488866Medicare PIN
CA00G4888610Medicare PIN
CA00G488864Medicare PIN
CA00G488867Medicare PIN
CA00G488863Medicare PIN
CAP00393826Medicare PIN
CA00G488860Medicare PIN
CA1336158567Medicaid
CA00G488869Medicare PIN
CACR331XMedicare PIN
CA00G488860Medicaid
CA00G488865Medicare PIN
CA300017827Medicare PIN
CA00G488868Medicare PIN