MEDICARE: DR. RANDY G HARTMAN DPM

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
1	213E00000X	Podiatrist	RH001180	MI

Other Identifiers

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

General Provider Information

NPI Number	:	1467492363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDY G HARTMAN DPM

Provider Business Mailing Address
First Line	:	3149 S LEE POINT RD
Second Line	:
City	:	SUTTONS BAY
State	:	MI
Zip	:	49682-9526
Country	:	US
Telephone Number	:	231-271-5210
Fax Number	:

Provider Business Practice Location Address
First Line	:	620 WOODMERE AVE
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-3397
Country	:	US
Telephone Number	:	231-946-8822
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	04/22/2021

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