Healthcare Provider Details

I. General information

NPI: 1164418042
Provider Name (Legal Business Name): ELIAS HAZZI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E MICHIGAN AVE STE 307
JACKSON MI
49201-1850
US

IV. Provider business mailing address

1100 E MICHIGAN AVE STE 307
JACKSON MI
49201-1850
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-1594
  • Fax: 641-226-5024
Mailing address:
  • Phone: 517-205-1594
  • Fax: 517-205-1540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number35243
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: