Healthcare Provider Details

I. General information

NPI: 1235194150
Provider Name (Legal Business Name): STEVEN WADE HARTMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 N SENATE AVE
INDIANAPOLIS IN
46202-2213
US

IV. Provider business mailing address

1520 N SENATE AVE
INDIANAPOLIS IN
46202-2213
US

V. Phone/Fax

Practice location:
  • Phone: 317-962-8893
  • Fax: 317-962-6722
Mailing address:
  • Phone: 317-962-8893
  • Fax: 317-962-6722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01028964
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: