Provider Demographics
NPI:1700960515
Name:HARTLEY, MICHAEL P (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:HARTLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1100 SOUTHFIELD DR
Mailing Address - Street 2:SUITE 1370
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-4498
Mailing Address - Country:US
Mailing Address - Phone:317-837-5571
Mailing Address - Fax:317-837-5580
Practice Address - Street 1:100 HOSPITAL LN
Practice Address - Street 2:SUITE 100
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-1989
Practice Address - Country:US
Practice Address - Phone:317-745-7310
Practice Address - Fax:317-745-7320
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01056831A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200875670Medicaid
354590TTMedicare PIN