Provider Demographics
NPI:1740261452
Name:HAZELCORN, STEVEN LEONARD (DO)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:LEONARD
Last Name:HAZELCORN
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 1:1665 STONE CREEK LN
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-1057
Mailing Address - Country:US
Mailing Address - Phone:330-425-0701
Mailing Address - Fax:
Practice Address - Street 1:1665 STONE CREEK LN
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-1057
Practice Address - Country:US
Practice Address - Phone:330-425-0701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007986207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2610115Medicaid
WVHA4172768Medicare PIN
OH4172765Medicare PIN
OH2610115Medicaid