Provider Demographics
NPI:1619034162
Name:BASIL H HAZIMAH, DPM, INC
Entity Type:Organization
Organization Name:BASIL H HAZIMAH, DPM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BASIL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAZIMAH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:614-875-5233
Mailing Address - Street 1:2545 HILLIARD ROME RD PMB 222
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-9471
Mailing Address - Country:US
Mailing Address - Phone:614-875-5233
Mailing Address - Fax:614-568-7407
Practice Address - Street 1:3841 BROADWAY
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-2206
Practice Address - Country:US
Practice Address - Phone:614-875-5233
Practice Address - Fax:614-568-7407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9312031Medicare ID - Type Unspecified