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Individual
ROY ALDEN HART
Active
Individual
ROY ALDEN HART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
036081158
IL
207V00000X
Obstetrics & Gynecology Physician
Primary
5315029112
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01967
LICENSE NUMBER
IA
05
—
036021158
—
IL
05
—
114945064
—
MI
01
—
160G360190
BCBSM GROUP PIN
MI
01
—
381870664
TAX ID
MI
01
—
5315029112
STATE LICENSE
MI
01
—
RH007937
LICENSE
MI
Enumeration date
06/22/2005
Last updated
05/20/2008
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