Provider Demographics
NPI:1275535650
Name:HAZAN, TOBY (MD)
Entity Type:Individual
Prefix:
First Name:TOBY
Middle Name:
Last Name:HAZAN
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 1:1703 BELLWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-2601
Mailing Address - Country:US
Mailing Address - Phone:248-932-2500
Mailing Address - Fax:
Practice Address - Street 1:1703 BELLWOOD CT
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-2601
Practice Address - Country:US
Practice Address - Phone:248-932-2500
Practice Address - Fax:248-932-2506
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010351112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4182959Medicaid
MIA78261Medicare UPIN