Provider Demographics
NPI:1033326376
Name:HAZEL DELL PEDIATRAICS, LLC
Entity Type:Organization
Organization Name:HAZEL DELL PEDIATRAICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:LUCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-843-9554
Mailing Address - Street 1:13250 HAZEL DELL PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-8521
Mailing Address - Country:US
Mailing Address - Phone:317-843-9475
Mailing Address - Fax:317-843-9476
Practice Address - Street 1:13250 HAZEL DELL PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-8521
Practice Address - Country:US
Practice Address - Phone:317-843-9475
Practice Address - Fax:317-843-9476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care