Healthcare Provider Details

I. General information

NPI: 1295868230
Provider Name (Legal Business Name): DAVID W HAZEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 EAST JEFFERSON AVE
DETROIT MI
48207
US

IV. Provider business mailing address

2151 EAST JEFFERSON AVE
DETROIT MI
48207
US

V. Phone/Fax

Practice location:
  • Phone: 313-259-7990
  • Fax: 313-259-7294
Mailing address:
  • Phone: 313-259-7990
  • Fax: 313-259-7294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number35055101
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number4301052098
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: