MEDICARE: DR. ADRIENNE SARAH HIATT M.D.

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	208000000X	Pediatrics Physician	EMC0002578	MI
2	208D00000X	General Practice Physician	T9703	TX
3	208D00000X	General Practice Physician	01073071A	IN
4	208000000X	Pediatrics Physician	T9703	TX

General Provider Information

NPI Number	:	1194090894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADRIENNE SARAH HIATT M.D.

Provider Business Mailing Address
First Line	:	604 E BAILEY BOSWELL RD STE 140
Second Line	:
City	:	SAGINAW
State	:	TX
Zip	:	76131-3568
Country	:	US
Telephone Number	:	817-484-6610
Fax Number	:

Provider Business Practice Location Address
First Line	:	604 E BAILEY BOSWELL RD STE 140
Second Line	:
City	:	SAGINAW
State	:	TX
Zip	:	76131-3568
Country	:	US
Telephone Number	:	817-484-6610
Fax Number	:

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

Provider Enumeration Date	:	03/13/2012
Last Update Date	:	07/25/2023

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