Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 35243 | IA |
NPI | 1164418042 |
---|---|
Provider Name | Elias Hazzi |
First Address | Jackson, MI 49201-1850 |
Second Address | Jackson, MI 49201-1850 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2005 |
Last Update Date | 26/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0418582 | (05) | IA |
1418582 | (05) | IA |
35243 | MEDICAL LICENSE (01) | IA |
H93745 | (02) | |
P00121777 | RR MEDICARE CV (01) | IA |
P00161383 | RR MEDICARE ONC (01) | IA |