Healthcare Provider Details

I. General information

NPI: 1831405968
Provider Name (Legal Business Name): KENNETH JOHN HARTMAN C.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2010
Last Update Date: 08/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 N WILLOW HWY
LANSING MI
48917-1644
US

IV. Provider business mailing address

1825 N WILLOW HWY
LANSING MI
48917-1644
US

V. Phone/Fax

Practice location:
  • Phone: 517-886-5798
  • Fax: 517-886-1548
Mailing address:
  • Phone: 517-886-5798
  • Fax: 517-886-1548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: