Individual
DR. NICHOLAS L HARTOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3271 CLEAR VISTA CT NE, GRAND RAPIDS, MI 49525-9477
(616) 267-7125
(616) 267-9593
Mailing address
100 MICHIGAN ST NE, MC 845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
2014010402
MO
207K00000X
Allergy & Immunology Physician
Primary
4301108955
MI
207R00000X
Internal Medicine Physician
R-9168
IA
Other
Enumeration date
05/30/2011
Last updated
03/17/2021
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