Basic Information
| Provider Information | |||||||||
| NPI: | 1790891596 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAZNECI | ||||||||
| FirstName: | SINA | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 21610 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432210610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009237963 | ||||||||
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| Practice Location | |||||||||
| Address1: | 615 FULTON ST | ||||||||
| Address2: | |||||||||
| City: | PORT CLINTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434522001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197343131 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2006 | ||||||||
| LastUpdateDate: | 01/17/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 35-05-6761-H | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 0766149 | 05 | OH | MEDICAID |