| Doctor Name: | DR. STEPHEN J HARTSOCK |
| NPI Number: | 1114938453 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 036110046 |
| Business Practice Address: | 1115 Ronald Reagan Pkwy Ste 148 Avon, IN - 461236910 |
| Business Phone Number: | 3179628893 |
| Business Fax Number: | 3179626722 |
| Mailing Address: | 250 N Shadeland Ave, Ste 130 - Provider Enrollment INDIANAPOLIS |
| State: | IN |
| Postal Code: | 462194959 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 08/11/2006 |
| NPI Last Update Date: | 03/25/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 036110046 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |