Basic Information
Provider Information | |||||||||
NPI: | 1437387446 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HARTMAN | ||||||||
FirstName: | NICHOLAS | ||||||||
MiddleName: | D | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D., M.P.H. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 259 E ERIE ST | ||||||||
Address2: | SUITE 100 | ||||||||
City: | CHICAGO | ||||||||
State: | IL | ||||||||
PostalCode: | 606112930 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3129269512 | ||||||||
FaxNumber: | 3129266274 | ||||||||
Practice Location | |||||||||
Address1: | 645 N MICHIGAN AVE | ||||||||
Address2: | SUITE 1058 A | ||||||||
City: | CHICAGO | ||||||||
State: | IL | ||||||||
PostalCode: | 606112826 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3129269512 | ||||||||
FaxNumber: | 3129266274 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/29/2009 | ||||||||
LastUpdateDate: | 06/29/2009 | ||||||||
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 | 207P00000X | 125055846 | IL | Y |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 125055846 | 01 | IL | IL TEMPORARY MEDICAL LICENSE, STATUS - ACTIVE | OTHER |