Healthcare Provider Details

I. General information

NPI: 1457098212
Provider Name (Legal Business Name): ALEXANDER CHARLES HALL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2022
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 JOHN R ST
DETROIT MI
48201-2013
US

IV. Provider business mailing address

4201 SAINT ANTOINE ST # 9C
DETROIT MI
48201-2153
US

V. Phone/Fax

Practice location:
  • Phone: 616-540-9367
  • Fax:
Mailing address:
  • Phone: 313-745-5146
  • Fax: 313-966-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number5101028537
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: