Healthcare Provider Details

I. General information

NPI: 1285136010
Provider Name (Legal Business Name): HALA AL-HUMADI H.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 S GULLEY RD STE E
DEARBORN MI
48124-4407
US

IV. Provider business mailing address

3231 S GULLEY RD STE E
DEARBORN MI
48124-4407
US

V. Phone/Fax

Practice location:
  • Phone: 313-278-2327
  • Fax:
Mailing address:
  • Phone: 313-278-2327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: