Healthcare Provider Details

I. General information

NPI: 1487193686
Provider Name (Legal Business Name): MICHAEL A. HARTMAN DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12885 NORTHLINE RD
SOUTHGATE MI
48195-1181
US

IV. Provider business mailing address

5226 GREEN RD
WEST BLOOMFIELD MI
48323-2718
US

V. Phone/Fax

Practice location:
  • Phone: 734-283-3777
  • Fax: 734-324-2598
Mailing address:
  • Phone: 734-455-3669
  • Fax: 734-455-3797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberMH001532
License Number StateMI

VIII. Authorized Official

Name: DR. MICHAEL ALAN HARTMAN
Title or Position: OWNER
Credential: DPM
Phone: 734-455-3669