Provider Demographics
NPI:1225013576
Name:HAZLETT FAMILY HEALTH CARE, P.C.
Entity Type:Organization
Organization Name:HAZLETT FAMILY HEALTH CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORAZON
Authorized Official - Middle Name:C
Authorized Official - Last Name:HAZLETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-425-8042
Mailing Address - Street 1:2925 N SAINT JOSEPH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47720-1337
Mailing Address - Country:US
Mailing Address - Phone:812-425-8042
Mailing Address - Fax:
Practice Address - Street 1:2925 N SAINT JOSEPH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47720-1337
Practice Address - Country:US
Practice Address - Phone:812-425-8042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044154A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ING57520Medicare UPIN
IN182600Medicare ID - Type Unspecified