MEDICARE: LYNETTE HAZELBAKER 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	207R00000X	Internal Medicine Physician	01030216	IN

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

General Provider Information

NPI Number	:	1841211570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNETTE HAZELBAKER M.D.

Provider Business Mailing Address
First Line	:	3508 S LAFOUNTAIN ST
Second Line	:
City	:	KOKOMO
State	:	IN
Zip	:	46902-3803
Country	:	US
Telephone Number	:	765-864-8727
Fax Number	:	765-864-8715

Provider Business Practice Location Address
First Line	:	3508 S LAFOUNTAIN ST
Second Line	:
City	:	KOKOMO
State	:	IN
Zip	:	46902-3803
Country	:	US
Telephone Number	:	765-864-8727
Fax Number	:	765-864-8715

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	09/13/2016

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