Individual
LYNETTE HAZELBAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3508 S LAFOUNTAIN ST, KOKOMO, IN 46902-3803
(765) 864-8727
(765) 864-8715
Mailing address
3508 S LAFOUNTAIN ST, KOKOMO, IN 46902-3803
(765) 864-8727
(765) 864-8715
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01030216
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100137490B
—
IN
Enumeration date
07/21/2006
Last updated
09/13/2016
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