Basic Information
| Provider Information | |||||||||
| NPI: | 1639318892 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DONALD J HARDMAN MD PC | ||||||||
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| OtherOrganizationName: | EAST MICHIGAN MEDICAL ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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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 | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485073022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8108208121 | ||||||||
| FaxNumber: | 8108208335 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2009 | ||||||||
| LastUpdateDate: | 01/06/2016 | ||||||||
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| AuthorizedOfficialLastName: | HARDMAN | ||||||||
| AuthorizedOfficialFirstName: | DONALD | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8108208121 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301062726 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0B50030 | 01 | MI | BCBSM GROUP | OTHER |