Provider Demographics
NPI:1346537685
Name:HIDRADENITIS SUPPURATIVA INSTITUTE, LLC
Entity Type:Organization
Organization Name:HIDRADENITIS SUPPURATIVA INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:G
Authorized Official - Last Name:HAZEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-249-0274
Mailing Address - Street 1:26908 DETROIT RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2398
Mailing Address - Country:US
Mailing Address - Phone:440-249-0274
Mailing Address - Fax:440-808-1606
Practice Address - Street 1:26908 DETROIT RD
Practice Address - Street 2:SUITE 103
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2398
Practice Address - Country:US
Practice Address - Phone:440-249-0274
Practice Address - Fax:440-808-1606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH037749207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty