Provider Demographics
NPI:1447516257
Name:HARTLINE, JOHN VINCENT (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:VINCENT
Last Name:HARTLINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1259 PRESTWICK LN
Mailing Address - Street 2:
Mailing Address - City:ITASCA
Mailing Address - State:IL
Mailing Address - Zip Code:60143-1975
Mailing Address - Country:US
Mailing Address - Phone:630-773-0036
Mailing Address - Fax:630-773-0048
Practice Address - Street 1:1259 PRESTWICK LN
Practice Address - Street 2:
Practice Address - City:ITASCA
Practice Address - State:IL
Practice Address - Zip Code:60143-1975
Practice Address - Country:US
Practice Address - Phone:630-773-0036
Practice Address - Fax:630-773-0048
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010334412080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine