Provider Demographics
NPI:1801868252
Name:HARTMAN, MARK D (DPM)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:HARTMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 N 9TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-3909
Mailing Address - Country:US
Mailing Address - Phone:515-574-6890
Mailing Address - Fax:
Practice Address - Street 1:804 KENYON RD
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5742
Practice Address - Country:US
Practice Address - Phone:515-574-6880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00587213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U59696Medicare UPIN
IAI3346Medicare PIN