Healthcare Provider Details

I. General information

NPI: 1912929829
Provider Name (Legal Business Name): HARTBERG MEDICAL CLINIC P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2170 HOSPITAL DR
WINDOM MN
56101-1287
US

IV. Provider business mailing address

PO BOX 249
WINDOM MN
56101-0249
US

V. Phone/Fax

Practice location:
  • Phone: 507-831-1422
  • Fax: 507-831-4783
Mailing address:
  • Phone: 507-831-1422
  • Fax: 507-831-4783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1292
License Number StateMN

VIII. Authorized Official

Name: DR. STEVEN PAUL HARTBERG
Title or Position: OWNER
Credential: MD
Phone: 507-831-1422