Healthcare Provider Details

I. General information

NPI: 1093370413
Provider Name (Legal Business Name): ALLISON JEAN HAZY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N PARK ST
KALAMAZOO MI
49007-3731
US

IV. Provider business mailing address

200 N PARK ST
KALAMAZOO MI
49007-3731
US

V. Phone/Fax

Practice location:
  • Phone: 269-382-2500
  • Fax:
Mailing address:
  • Phone: 269-382-2500
  • Fax: 269-373-7477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number101311
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number4351044228
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: