Healthcare Provider Details

I. General information

NPI: 1104347178
Provider Name (Legal Business Name): BENJAMIN HARTGER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 44TH ST SW STE 500
WYOMING MI
49509-7200
US

IV. Provider business mailing address

1621 44TH ST SW STE 500
WYOMING MI
49509-7200
US

V. Phone/Fax

Practice location:
  • Phone: 616-538-4442
  • Fax: 616-538-4843
Mailing address:
  • Phone: 616-538-4442
  • Fax: 616-538-4843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901002701
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901002701
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: