MEDICARE: RICHARD A. HALL, D.O., PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	5101007053	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5709132	OTHER	MI	BLUE CARE NETWORK
3	0857901324	OTHER	MI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1932375813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD A. HALL, D.O., PLC

Provider Business Mailing Address
First Line	:	4674 HILL ST
Second Line	:
City	:	CASS CITY
State	:	MI
Zip	:	48726-1009
Country	:	US
Telephone Number	:	989-872-4725
Fax Number	:

Provider Business Practice Location Address
First Line	:	4674 HILL ST
Second Line	:
City	:	CASS CITY
State	:	MI
Zip	:	48726-1009
Country	:	US
Telephone Number	:	989-872-4725
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RICHARD A HALL
Credential	:	DO
Telephone Number	:	989-872-4725

Provider Enumeration Date	:	05/01/2008
Last Update Date	:	05/01/2008

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