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1164418042

NPI Code Detail

MEDICARE: ELIAS HAZZI MD

MEDICARE: ELIAS HAZZI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RX0202X	Medical Oncology Physician	35243	IA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00121777	OTHER	IA	RR MEDICARE CV
5	P00161383	OTHER	IA	RR MEDICARE ONC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	35243	OTHER	IA	MEDICAL LICENSE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164418042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIAS HAZZI MD

Provider Business Mailing Address
First Line	:	1100 E MICHIGAN AVE STE 307
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-1850
Country	:	US
Telephone Number	:	517-205-1594
Fax Number	:	517-205-1540

Provider Business Practice Location Address
First Line	:	1100 E MICHIGAN AVE STE 307
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-1850
Country	:	US
Telephone Number	:	517-205-1594
Fax Number	:	641-226-5024

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	02/26/2021

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Directions to “ ELIAS HAZZI MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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