Individual
BASIL H HAZIMAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1235 CEDAR CT, CARBONDALE, IL 62901-5335
(618) 457-0431
(618) 457-5199
Mailing address
PO BOX 997, CARBONDALE, IL 62903-0997
(618) 457-0431
(618) 457-5199
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
0160053701
IL
213ES0103X
Foot & Ankle Surgery Podiatrist
36003066H
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016005370
—
IL
01
—
03922239
BLUE CROSS/BLUE SHIELD
IL
01
—
CI5845
RAILROAD MEDICARE
IL
Enumeration date
01/03/2007
Last updated
09/16/2008
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