Individual
DR. STEPHEN J HARTSOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1115 RONALD REAGAN PKWY, STE 148, AVON, IN 46123-6910
(317) 962-8893
(317) 962-6722
Mailing address
250 N SHADELAND AVE, STE 130 - PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
036110046
IL
207Q00000X
Family Medicine Physician
01072804A
IN
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
01072804A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201166240
—
IN
01
—
336070768
CONTROLLED SUBSTANCE #
IL
Enumeration date
08/11/2006
Last updated
03/07/2023
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