Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4674 HILL ST
CASS CITY MI
48726-1009
US

IV. Provider business mailing address

4674 HILL ST
CASS CITY MI
48726-1009
US

V. Phone/Fax

Practice location:
  • Phone: 989-872-4725
  • Fax:
Mailing address:
  • Phone: 989-872-4725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101007053
License Number StateMI

VIII. Authorized Official

Name: DR. RICHARD A HALL
Title or Position: OWNER
Credential: DO
Phone: 989-872-4725