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NPI Code Detail

MEDICARE: ANTONELLA HART

MEDICARE: ANTONELLA HART
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
1363LP2300XPrimary Care Nurse Practitioner4704253365MI
2363LA2200XAdult Health Nurse Practitioner4704253365MI

General Provider Information

NPI Number : 1881023729
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTONELLA HART
Provider Business Mailing Address
First Line : 1 FORD PL STE 3A
Second Line :
City : DETROIT
State : MI
Zip : 48202-3450
Country : US
Telephone Number : 313-874-4806
Fax Number :
Provider Business Practice Location Address
First Line : 14500 HALL RD
Second Line :
City : STERLING HEIGHTS
State : MI
Zip : 48313-1229
Country : US
Telephone Number : 586-566-4281
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2013
Last Update Date : 01/05/2026

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