Healthcare Provider Details

I. General information

NPI: 1255370748
Provider Name (Legal Business Name): DAVID A HARTMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 S KALAMAZOO MALL SUITE 204
KALAMAZOO MI
49007-4832
US

IV. Provider business mailing address

125 S KALAMAZOO MALL SUITE 204
KALAMAZOO MI
49007-4832
US

V. Phone/Fax

Practice location:
  • Phone: 269-343-3900
  • Fax: 269-343-5640
Mailing address:
  • Phone: 269-343-3900
  • Fax: 269-343-5640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number4301051203
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: