=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073162046
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL A HART PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2019
-----------------------------------------------------
Last Update Date | 08/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9750 W PEORIA AVE
-----------------------------------------------------
City | PEORIA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85345-6108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-281-1620
-----------------------------------------------------
Fax | 623-281-1622
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20280 N 59TH AVE # 115-743
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85308-6850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-262-1010
-----------------------------------------------------
Fax | 480-914-1425
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. MICHAEL ANDREW HART
-----------------------------------------------------
Credential | FNP-C
-----------------------------------------------------
Telephone | 623-262-1010
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------