Healthcare Provider Details

I. General information

NPI: 1578676847
Provider Name (Legal Business Name): MICHAEL ALAN HARTMAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 12/21/2025
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12885 NORTHLINE RD
SOUTHGATE MI
48195-1181
US

IV. Provider business mailing address

12885 NORTHLINE RD STE 1
SOUTHGATE MI
48195-1186
US

V. Phone/Fax

Practice location:
  • Phone: 734-283-3777
  • Fax: 734-455-3797
Mailing address:
  • Phone: 734-283-3777
  • 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:
Title or Position:
Credential:
Phone: