MEDICARE: DR. CORAZON C. HAZLETT 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	207Q00000X	Family Medicine Physician	01044154A	IN

General Provider Information

NPI Number	:	1619952942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CORAZON C. HAZLETT M.D.

Provider Business Mailing Address
First Line	:	2925 N SAINT JOSEPH AVE
Second Line	:	SUITE B
City	:	EVANSVILLE
State	:	IN
Zip	:	47720-1337
Country	:	US
Telephone Number	:	812-425-8042
Fax Number	:	812-425-1850

Provider Business Practice Location Address
First Line	:	2925 N SAINT JOSEPH AVE
Second Line	:	SUITE B
City	:	EVANSVILLE
State	:	IN
Zip	:	47720-1337
Country	:	US
Telephone Number	:	812-425-8042
Fax Number	:

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

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	08/10/2010

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