Provider Demographics
NPI:1730990227
Name:HAZEM, ROSE (PA)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:HAZEM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:14103 CAMELOT DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-2429
Mailing Address - Country:US
Mailing Address - Phone:586-447-6344
Mailing Address - Fax:
Practice Address - Street 1:14103 CAMELOT DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-2429
Practice Address - Country:US
Practice Address - Phone:586-447-6344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant