Healthcare Provider Details

I. General information

NPI: 1821787417
Provider Name (Legal Business Name): NICHOLAS G HALLENBECK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E MICHIGAN AVE
LANSING MI
48912-1811
US

IV. Provider business mailing address

1200 E MICHIGAN AVE STE 245
LANSING MI
48912-1897
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-5710
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5151016012
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: