Provider Demographics
NPI:1104347178
Name:HARTGER, BENJAMIN (DPM)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:HARTGER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 44TH ST SW STE 500
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-7200
Mailing Address - Country:US
Mailing Address - Phone:616-538-4442
Mailing Address - Fax:616-538-4843
Practice Address - Street 1:600 PARK AVE STE 3
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2173
Practice Address - Country:US
Practice Address - Phone:616-846-3400
Practice Address - Fax:616-846-3406
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002701213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist