Provider Demographics
NPI:1548221492
Name:HIATT, KARL B (MD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:B
Last Name:HIATT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4540 E BASELINE RD
Mailing Address - Street 2:#117
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206
Mailing Address - Country:US
Mailing Address - Phone:480-844-1410
Mailing Address - Fax:480-844-2723
Practice Address - Street 1:4540 E BASELINE RD
Practice Address - Street 2:#117
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206
Practice Address - Country:US
Practice Address - Phone:480-844-1410
Practice Address - Fax:480-844-2723
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ192302086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D55050Medicare UPIN
AZMD19230Medicare ID - Type Unspecified