MEDICARE: DR. MELODY LYNNE HARTMAN AUD

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	231H00000X	Audiologist	147000435	IL

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	:	1568483121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELODY LYNNE HARTMAN AUD

Provider Business Mailing Address
First Line	:	2673 HICKORY AVE
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61114-6209
Country	:	US
Telephone Number	:	815-494-4282
Fax Number	:

Provider Business Practice Location Address
First Line	:	1253 N. ALPINE ROAD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-2201
Country	:	US
Telephone Number	:	779-696-9201
Fax Number	:	815-397-9667

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	04/21/2022

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