Healthcare Provider Details

I. General information

NPI: 1386931764
Provider Name (Legal Business Name): MICHAEL HALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 12/27/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5995 SW 71ST ST # 1B
SOUTH MIAMI FL
33143-3531
US

IV. Provider business mailing address

5995 SW 71ST ST # 1B
SOUTH MIAMI FL
33143-3531
US

V. Phone/Fax

Practice location:
  • Phone: 305-669-6833
  • Fax:
Mailing address:
  • Phone: 305-669-6833
  • Fax: 305-666-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberME120828
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number077882
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: