MEDICARE: JOHN D HARTMAN 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	207Q00000X	Family Medicine Physician	2004014269	MO
2	207Q00000X	Family Medicine Physician	036111331	IL
3	207Q00000X	Family Medicine Physician	2004014269	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851399976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN D HARTMAN MD

Provider Business Mailing Address
First Line	:	201 BAILEY LANE
Second Line	:
City	:	BENTON
State	:	IL
Zip	:	62812-0000
Country	:	US
Telephone Number	:	618-439-3161
Fax Number	:	618-439-4049

Provider Business Practice Location Address
First Line	:	201 BAILEY LANE
Second Line	:
City	:	BENTON
State	:	IL
Zip	:	62812-0000
Country	:	US
Telephone Number	:	618-439-3161
Fax Number	:	618-439-4049

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	01/19/2012

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Directions to “ JOHN D HARTMAN MD” Practice Location

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