Provider Demographics
NPI:1609820331
Name:GHAZARIAN, HAGOP P (DPM)
Entity Type:Individual
Prefix:DR
First Name:HAGOP
Middle Name:P
Last Name:GHAZARIAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8748 PINE ISLAND CT S
Mailing Address - Street 2:
Mailing Address - City:MATTAWAN
Mailing Address - State:MI
Mailing Address - Zip Code:49071-9555
Mailing Address - Country:US
Mailing Address - Phone:269-353-7277
Mailing Address - Fax:269-353-7277
Practice Address - Street 1:8748 PINE ISLAND CT S
Practice Address - Street 2:
Practice Address - City:MATTAWAN
Practice Address - State:MI
Practice Address - Zip Code:49071-9555
Practice Address - Country:US
Practice Address - Phone:269-353-7277
Practice Address - Fax:269-353-7277
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001642213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3526895Medicaid
4858000160OtherBCBS
4858000160OtherBCBS
U56208Medicare UPIN