Physician Compare National (NPI:1982823688)

HEALTHCARE PROVIDER: DAVID RANDALL HANTKE M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1982823688
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2264528231
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20071022000839
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	HANTKE
	Individual professional last name
Provider First Name	DAVID
	Individual professional first name
Provider Middle Name	RANDALL
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF CALIFORNIA, GEFFEN SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1981
	Individual professional's medical school graduation year
Primary Specialty	OTOLARYNGOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	2807 LOMA VISTA RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 103
	Group Practice or individual's line 2 address
City	VENTURA
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	930031563
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	050394
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	COMMUNITY MEMORIAL HOSPITAL SAN BUENAVENTURA
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y