Provider Demographics
NPI:1831405968
Name:HARTMAN, KENNETH JOHN (CO)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:JOHN
Last Name:HARTMAN
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 N WILLOW HWY
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-1644
Mailing Address - Country:US
Mailing Address - Phone:517-886-5798
Mailing Address - Fax:517-886-1548
Practice Address - Street 1:1825 N WILLOW HWY
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-1644
Practice Address - Country:US
Practice Address - Phone:517-886-5798
Practice Address - Fax:517-886-1548
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter