MEDICARE: PREMIER CONCIERGE MEDICINE

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1669338455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER CONCIERGE MEDICINE

Provider Business Mailing Address
First Line	:	13 RESERVE BLVD
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78414-3596
Country	:	US
Telephone Number	:	310-408-0227
Fax Number	:

Provider Business Practice Location Address
First Line	:	6202 DUNBARTON OAK ST STE 200A
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78414-4303
Country	:	US
Telephone Number	:	361-391-5056
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN OWNER
Name	:	MARIANNE HAZELITT
Credential	:	DO
Telephone Number	:	310-408-0227

Provider Enumeration Date	:	12/24/2025
Last Update Date	:	04/21/2026

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