Provider Demographics
NPI:1639307408
Name:HANZEL, RICHARD GARRETT (DO)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:GARRETT
Last Name:HANZEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1557 VENICE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-4063
Mailing Address - Country:US
Mailing Address - Phone:954-471-0022
Mailing Address - Fax:
Practice Address - Street 1:1557 VENICE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4063
Practice Address - Country:US
Practice Address - Phone:954-471-0022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101018389207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine