MEDICARE: DR. DAVID W HART MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	28056	AL
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	01058431A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000001016083	OTHER	IN	ANTHEM PTAN
2	000001222577	OTHER	IN	ANTHEM PTAN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	000000732522	OTHER	IN	ANTHEM PTAN
6	51541799	OTHER	AL	BCBS

General Provider Information

NPI Number	:	1639276199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID W HART MD

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	707 W 2ND ST
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47403-2209
Country	:	US
Telephone Number	:	812-334-5081
Fax Number	:	812-339-8344

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2006
Last Update Date	:	05/21/2025

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Directions to “ DR. DAVID W HART MD” Practice Location

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