MEDICARE: BASIL H HAZIMAH, DPM, INC

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	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1619034162
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BASIL H HAZIMAH, DPM, INC

Provider Business Mailing Address
First Line	:	2545 HILLIARD ROME RD PMB 222
Second Line	:
City	:	HILLIARD
State	:	OH
Zip	:	43026-9471
Country	:	US
Telephone Number	:	614-875-5233
Fax Number	:	614-568-7407

Provider Business Practice Location Address
First Line	:	3841 BROADWAY
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-2206
Country	:	US
Telephone Number	:	614-875-5233
Fax Number	:	614-568-7407

Authorized Official
Title or Position	:	OWNER
Name	:	BASIL HAZIMAH
Credential	:	DPM
Telephone Number	:	614-875-5233

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	05/22/2008

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