Basic Information
Provider Information | |||||||||
NPI: | 1063743433 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HARDT | ||||||||
FirstName: | KEVIN | ||||||||
MiddleName: | D | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 676 N SAINT CLAIR ST | ||||||||
Address2: | SUITE 1350 | ||||||||
City: | CHICAGO | ||||||||
State: | IL | ||||||||
PostalCode: | 606112927 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3126956800 | ||||||||
FaxNumber: | 3126952771 | ||||||||
Practice Location | |||||||||
Address1: | 259 E ERIE ST | ||||||||
Address2: | 13TH FLOOR | ||||||||
City: | CHICAGO | ||||||||
State: | IL | ||||||||
PostalCode: | 606112987 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3126956800 | ||||||||
FaxNumber: | 3126952771 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/24/2010 | ||||||||
LastUpdateDate: | 12/19/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 036.135577 | IL | Y |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   |
No ID Information.