Provider Demographics
NPI:1164418042
Name:HAZZI, ELIAS (MD)
Entity Type:Individual
Prefix:
First Name:ELIAS
Middle Name:
Last Name:HAZZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 E MICHIGAN AVE STE 307
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1850
Mailing Address - Country:US
Mailing Address - Phone:517-205-1594
Mailing Address - Fax:517-205-1540
Practice Address - Street 1:1100 E MICHIGAN AVE STE 307
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1850
Practice Address - Country:US
Practice Address - Phone:517-205-1594
Practice Address - Fax:641-226-5024
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35243207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1418582Medicaid
IA35243OtherMEDICAL LICENSE
IAP00121777OtherRR MEDICARE CV
IA0418582Medicaid
IAP00161383OtherRR MEDICARE ONC
IAP00161383OtherRR MEDICARE ONC
IA1418582Medicaid
IAI10514Medicare PIN