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Individual

GREGORY L HAZLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1787 GRAND RIDGE CT. NE, SUITE 101, GRAND RAPIDS, MI 49525
(616) 774-8131
(616) 774-8204
Mailing address
5900 BYRON CENTER AVE SW, MEDICAL ADMINISTRATION, WYOMING, MI 49519-9606
(616) 252-3242
(616) 252-0260

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301057607
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
080D17690
BLUE SHIELD
MI
05
2957048
MI
01
4558584
AETNA
MI
01
900000696
PRIORITY HEALTH
MI
Enumeration date
06/03/2006
Last updated
12/08/2017
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