Healthcare Provider Details

I. General information

NPI: 1750604526
Provider Name (Legal Business Name): HALO MEDICAL GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2010
Last Update Date: 07/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 JOHN R ST SUITE 510
DETROIT MI
48201
US

IV. Provider business mailing address

22720 MICHIGAN AVE STE 200
DEARBORN MI
48124-2021
US

V. Phone/Fax

Practice location:
  • Phone: 313-993-7777
  • Fax: 313-993-2563
Mailing address:
  • Phone: 313-791-3000
  • Fax: 313-791-2800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704226174
License Number StateMI

VIII. Authorized Official

Name: DR. MAHIR DARRAR ELDER
Title or Position: CARDIOLOGIST
Credential: MD
Phone: 313-993-7777