Provider Demographics
NPI:1134342892
Name:HARDT, JOAN MICHELLE (MD)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:MICHELLE
Last Name:HARDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6208 WATERFORD BLVD APT 80
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-1112
Mailing Address - Country:US
Mailing Address - Phone:405-842-1100
Mailing Address - Fax:
Practice Address - Street 1:6424 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7322
Practice Address - Country:US
Practice Address - Phone:405-842-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21186174400000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered174400000XOther Service ProvidersSpecialist
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice