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General NPI Number Information
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NPI Number | 1962362418
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Entity Type | Individual
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Provider Name | GARY HAZEN
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Gender | Male
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Dates
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Enumeration Date | 11/17/2025
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Last Update Date | 11/17/2025
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Provider Practice Location Address
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Address Line | 1416 W EASTERDAY AVE
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City | SAULT SAINTE MARIE
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State | MI
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Zip | 49783-1415
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Country | US
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Telephone | 906-748-9010
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Fax |
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Provider Business Mailing Address
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Address Line | 100 MALTON RD
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City | NEGAUNEE
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State | MI
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Zip | 49866-2001
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Country | US
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Telephone | 906-228-9699
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Fax |
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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