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NPI Code Detail

MEDICARE: JONATHAN D HART M.D.

MEDICARE: JONATHAN D HART M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician01039715IN
2207Q00000XFamily Medicine Physician01039715AIN
3208M00000XHospitalist Physician01039715AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154300770
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN D HART M.D.
Provider Business Mailing Address
First Line : 2605 E CREEKS EDGE DR
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47401-8368
Country : US
Telephone Number : 812-355-2300
Fax Number : 812-355-2316
Provider Business Practice Location Address
First Line : 2605 E CREEKS EDGE DR
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47401-8368
Country : US
Telephone Number : 812-355-2300
Fax Number : 812-355-2316
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2006
Last Update Date : 09/09/2010

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Directions to “ JONATHAN D HART M.D.” Practice Location

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