Healthcare Provider Details

I. General information

NPI: 1548213465
Provider Name (Legal Business Name): MICHAEL J HART MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 73RD ST SUITE 21
WINDSOR HEIGHTS IA
50311-1321
US

IV. Provider business mailing address

2213 GRAND AVE
DES MOINES IA
50312-5305
US

V. Phone/Fax

Practice location:
  • Phone: 515-223-7177
  • Fax: 515-223-7321
Mailing address:
  • Phone: 515-237-3974
  • Fax: 515-883-2692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number StateIA

VIII. Authorized Official

Name: MICHAEL J HART
Title or Position: PRESIDENT/CEO
Credential: M.D.
Phone: 515-237-3974