MEDICARE: DAVID BURTON HARDIN MD

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	208D00000X	General Practice Physician	01039780A	IN
2	208100000X	Physical Medicine & Rehabilitation Physician	44907	TN
3	208100000X	Physical Medicine & Rehabilitation Physician	01039780A	IN
4	207R00000X	Internal Medicine Physician	01039780A	IN

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801836069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID BURTON HARDIN MD

Provider Business Mailing Address
First Line	:	635 S EARL AVE
Second Line	:	STE B
City	:	LAFAYETTE
State	:	IN
Zip	:	47904-3603
Country	:	US
Telephone Number	:	765-838-8208
Fax Number	:	765-838-8207

Provider Business Practice Location Address
First Line	:	8355 ROCKVILLE RD STE 120
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46234-2722
Country	:	US
Telephone Number	:	317-429-0061
Fax Number	:	317-222-1953

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	11/16/2018

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Directions to “ DAVID BURTON HARDIN MD” Practice Location

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