Provider Demographics
NPI:1528310596
Name:KARL B. HIATT, MD,PC
Entity type:Organization
Organization Name:KARL B. HIATT, MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:B
Authorized Official - Last Name:HIATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:480-844-1410
Mailing Address - Street 1:4540 E. BASELINE RD
Mailing Address - Street 2:#117
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4617
Mailing Address - Country:US
Mailing Address - Phone:480-844-1410
Mailing Address - Fax:480-844-2723
Practice Address - Street 1:4540 E. BASELINE RD
Practice Address - Street 2:#117
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4617
Practice Address - Country:US
Practice Address - Phone:480-844-1410
Practice Address - Fax:480-844-2723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-15
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD55050Medicare UPIN