Provider Demographics
NPI:1982095071
Name:RS HARTZ MD NAMPTP NEUROPATHY DR SC
Entity Type:Organization
Organization Name:RS HARTZ MD NAMPTP NEUROPATHY DR SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-637-0166
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:773-637-0166
Mailing Address - Fax:708-386-5547
Practice Address - Street 1:715 LAKE ST
Practice Address - Street 2:SUITE 900
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1422
Practice Address - Country:US
Practice Address - Phone:773-637-0166
Practice Address - Fax:708-386-5547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036051428208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty