Provider Demographics
NPI:1063437432
Name:HAZEN, RONALD C (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:C
Last Name:HAZEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1000 HOUGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-5303
Mailing Address - Country:US
Mailing Address - Phone:989-583-6812
Mailing Address - Fax:989-583-6915
Practice Address - Street 1:1000 HOUGHTON AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5303
Practice Address - Country:US
Practice Address - Phone:989-583-6812
Practice Address - Fax:989-583-6915
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301033940207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI124945OtherGREAT LAKES HEALTH PLAN
MI381870664OtherCOMMERCIAL
MI1063437432Medicaid
MI381870664OtherPRIVATE HEALTHCARE SYSTEM
MI7356092OtherBCBSM
MI160G360190OtherBCBSM
MI1005638OtherMCLAREN
MI1H36028OtherHEALTHPLUS
MI381870664OtherPPOM
MI381870664OtherHEALTH CARE ALLIANCE POOL
MI381870664129OtherCOMMUNITY CHOICE MICHIGAN
MI381870664OtherPRIORITY HEALTH
MI381870664OtherPRIMARY CARE PARTNERS
MIRH033940OtherLICENSE
MI7356092OtherBCBSM
MI381870664129OtherCOMMUNITY CHOICE MICHIGAN