Healthcare Provider Details

I. General information

NPI: 1023096948
Provider Name (Legal Business Name): MICHAEL W HARTMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 09/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ESPLANADE AVE SUITE 500
KENNER LA
70065-2489
US

IV. Provider business mailing address

1542 TULANE AVE BOX T6-7
NEW ORLEANS LA
70112-2865
US

V. Phone/Fax

Practice location:
  • Phone: 504-412-1700
  • Fax: 504-412-1701
Mailing address:
  • Phone: 504-568-4680
  • Fax: 504-568-4466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number44712
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number2007022052
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberMD.204132
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: