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General NPI Number Information
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NPI Number | 1851549901
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Entity Type | Individual
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Provider Name | KYLE J HAZELWOOD M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 4048 CEDAR BLUFF DR STE 1
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City | PETOSKEY
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State | MI
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Zip | 49770-8895
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Country | US
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Telephone | 231-347-5155
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Fax | 231-668-4082
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Provider Business Mailing Address
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Address Line | 4048 CEDAR BLUFF DR STE 1
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City | PETOSKEY
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State | MI
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Zip | 49770-8895
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Country | US
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Telephone | 231-347-5155
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Fax | 231-668-4082
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 46201
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 125052518
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 111422
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 4301511405
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License Number State | MI
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