Healthcare Provider Details

I. General information

NPI: 1386101293
Provider Name (Legal Business Name): HALO PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 03/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 E STATE FAIR
DETROIT MI
48203-1257
US

IV. Provider business mailing address

22720 MICHIGAN AVE STE 200
DEARBORN MI
48124-2021
US

V. Phone/Fax

Practice location:
  • Phone: 313-891-2740
  • Fax:
Mailing address:
  • Phone: 313-891-2740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: HANADY BEYDOUN
Title or Position: OFFICE MANAGER
Credential:
Phone: 313-993-7777