Healthcare Provider Details

I. General information

NPI: 1154632396
Provider Name (Legal Business Name): NICHOLAS HARTMANN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

PO BOX 16960
MIAMI FL
33101-6960
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-6837
  • Fax:
Mailing address:
  • Phone: 305-243-6837
  • Fax: 305-243-8470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN14940
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: