Provider Demographics
NPI:1619952942
Name:HAZLETT, CORAZON C (MD)
Entity Type:Individual
Prefix:DR
First Name:CORAZON
Middle Name:C
Last Name:HAZLETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 N SAINT JOSEPH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47720-1337
Mailing Address - Country:US
Mailing Address - Phone:812-425-8042
Mailing Address - Fax:812-425-1850
Practice Address - Street 1:2925 N SAINT JOSEPH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47720-1337
Practice Address - Country:US
Practice Address - Phone:812-425-8042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044154A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN182600Medicare ID - Type Unspecified
ING57520Medicare UPIN