Healthcare Provider Details

I. General information

NPI: 1801652870
Provider Name (Legal Business Name): HALO EP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22720 MICHIGAN AVE STE 200
DEARBORN MI
48124-2021
US

IV. Provider business mailing address

22720 MICHIGAN AVE STE 200
DEARBORN MI
48124-2021
US

V. Phone/Fax

Practice location:
  • Phone: 313-791-3000
  • Fax: 313-791-2800
Mailing address:
  • Phone: 313-791-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MAHIR ELDER
Title or Position: OWNER
Credential: MD
Phone: 313-791-3000