Healthcare Provider Details

I. General information

NPI: 1255387858
Provider Name (Legal Business Name): CHARLOTTE MEDICAL CENTER AND URGENT CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 MEIJER DR
CHARLOTTE MI
48813-8376
US

IV. Provider business mailing address

616 MEIJER DR
CHARLOTTE MI
48813-8376
US

V. Phone/Fax

Practice location:
  • Phone: 517-543-7800
  • Fax: 517-543-7900
Mailing address:
  • Phone: 517-543-7800
  • Fax: 517-543-7900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101012000
License Number StateMI

VIII. Authorized Official

Name: DR. DEBBIE HAYMOWATTEE HALLAK
Title or Position: MANAGER
Credential: D.O.
Phone: 517-543-7800