Healthcare Provider Details

I. General information

NPI: 1013407261
Provider Name (Legal Business Name): MEREDITH ANN HALLORAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18181 OAKWOOD BLVD
DEARBORN MI
48124-5032
US

IV. Provider business mailing address

2155 GRENADIER DR
TROY MI
48098-5216
US

V. Phone/Fax

Practice location:
  • Phone: 313-551-3745
  • Fax:
Mailing address:
  • Phone: 248-515-3436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: