Marybeth Hardwicke, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MH404922 Issued in MI

Practice address

23411 Jefferson Ave
Suite 100
Saint Clair Shores, MI 48080-1949

Phone

(586) 778-4080

Fax

(586) 778-6055

NPI assigned

Jul 11, 2005

Last updated

Apr 29, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• St Clair Adult Medicine PC

  • Internal Medicine Physician
  • Detroit, MI
  • NPI 1871529552
  NPD (past)
• St Clair Adult Medicine Specialists PC

  • Internal Medicine Physician
  • Saint Clair Shores, MI
  • NPI 1508864620
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1240963200000",
    "number": "1144228586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 673215",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482673215",
            "telephone_number": "586-778-4080",
            "fax_number": "586-778-6055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23411 JEFFERSON AVE",
            "address_2": "SUITE 100",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480801949",
            "telephone_number": "586-778-4080",
            "fax_number": "586-778-6055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARDWICKE",
        "first_name": "MARYBETH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-11",
        "last_updated": "2009-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "MH404922",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3384323",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alayna Hamze
• Wafaa S. Hanna, M.D.
• Julie A Hansen, CNM
• Julia Hanson, LMSW
• Kelli Harbin
• Harper Chiropractic Center P C
• Harper Urgent Care PLLC
• Rebecca Harrington
• Breanna Harris, LMSW
• Serita Hartley

• Internal Medicine Physician in Saint Clair Shores, MI
• Providers in Saint Clair Shores, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.