Basic Information
| Provider Information | |||||||||
| NPI: | 1013906700 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARDMAN | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3755 REMEMBRANCE RD NW | ||||||||
| Address2: | STE 1 | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495347745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6164534403 | ||||||||
| FaxNumber: | 6164532815 | ||||||||
| Practice Location | |||||||||
| Address1: | 3499 S LINDEN RD STE 2 | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485073022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8108208121 | ||||||||
| FaxNumber: | 8108208335 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2005 | ||||||||
| LastUpdateDate: | 02/08/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301062726 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110138160 | 01 | MI | METRAHEALTH | OTHER | 4516202 | 05 | MI | MEDICAID | 110B510530 | 01 | MI | B LUE CROSS BLUE SHIELD | OTHER | G41734 | 01 | MI | HEALTH ALLIANCE PLAN | OTHER | 0802503102 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | C5781 | 01 | MI | MCARE | OTHER | 5716508 | 01 | MI | AETNA | OTHER | 253179 | 01 | MI | HEALTH ADVANTAGE NETWORK | OTHER | 110B510530 | 01 | MI | BLUE CARE NETWORK | OTHER | 3153084010 | 01 | MI | CIGNA | OTHER | 0980010 | 01 | MI | HEALTH PLUS | OTHER | G41734 | 01 | MI | HEALTH NET FEDERAL | OTHER | 0B50030 | 01 | MI | BCBSM GROUP | OTHER | 253179 | 01 | MA | MCLAREN HEALTH PLAN | OTHER |