Healthcare Provider Details

I. General information

NPI: 1407906688
Provider Name (Legal Business Name): JONATHAN MICHAEL HARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 MARSH ST
MANKATO MN
56001-4752
US

IV. Provider business mailing address

915 N ALTADENA AVE
ROYAL OAK MI
48067-4409
US

V. Phone/Fax

Practice location:
  • Phone: 507-625-4031
  • Fax:
Mailing address:
  • Phone: 248-632-1144
  • Fax: 248-632-1477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301081674
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: