MEDICARE: HAZEL DELL PEDIATRAICS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1033326376
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAZEL DELL PEDIATRAICS, LLC

Provider Business Mailing Address
First Line	:	13250 HAZEL DELL PKWY
Second Line	:	SUITE 103
City	:	CARMEL
State	:	IN
Zip	:	46033-8521
Country	:	US
Telephone Number	:	317-843-9475
Fax Number	:	317-843-9476

Provider Business Practice Location Address
First Line	:	13250 HAZEL DELL PKWY
Second Line	:	SUITE 103
City	:	CARMEL
State	:	IN
Zip	:	46033-8521
Country	:	US
Telephone Number	:	317-843-9475
Fax Number	:	317-843-9476

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	CATHERINE J LUCE
Credential	:
Telephone Number	:	317-843-9554

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	08/22/2020

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