Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 36002487A | IN |
Y | 213ES0000X | Sports Medicine | 36002487A | IN |
NPI | 1306345194 |
---|---|
Provider Name | Cody Hartz |
First Address | Muncie, IN 47306 |
Second Address | Muncie, IN 47306-1022 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2018 |
Last Update Date | 07/02/2018 |