Healthcare Provider Details

I. General information

NPI: 1104182245
Provider Name (Legal Business Name): HARTMUTH BRUNO BITTNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 ST FRANCIS WAY STE 200
LAFAYETTE IN
47905-4940
US

IV. Provider business mailing address

2650 WARRENVILLE RD STE 280
DOWNERS GROVE IL
60515-2075
US

V. Phone/Fax

Practice location:
  • Phone: 765-775-2800
  • Fax:
Mailing address:
  • Phone: 630-324-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number2019012964
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME112494
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number35137046
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number036150312
License Number StateIL
# 5
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number46889
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: