Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 036-109982 | IL |
Y | 207P00000X | Emergency Physician | 60901-20 | WI |
NPI | 1013073253 |
---|---|
Provider Name | Michael J. Hartmann |
First Address | Janesville, WI 53548-2940 |
Second Address | Janesville, WI 53548 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2006 |
Last Update Date | 24/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000054176-K400095937 | WI MEDICARE (01) | WI |
036109982 | (05) | IL |
1013073253 | (05) | WI |
1013073253 | BCBSWI (01) | WI |
HARTMMI4 | MERCYCARE INSURANCE (01) | WI |
I19819 | (02) | IL |