Healthcare Provider Details

I. General information

NPI: 1215494125
Provider Name (Legal Business Name): HALO PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

17600 W WARREN AVE
DETROIT MI
48228-3509
US

IV. Provider business mailing address

22720 MICHIGAN AVE STE 200
DEARBORN MI
48124-2021
US

V. Phone/Fax

Practice location:
  • Phone: 313-450-4411
  • Fax:
Mailing address:
  • Phone: 313-450-4411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

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