Healthcare Provider Details

I. General information

NPI: 1962035741
Provider Name (Legal Business Name): MACGREGOR HALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2848 NILES RD
SAINT JOSEPH MI
49085-3352
US

IV. Provider business mailing address

2848 NILES RD
SAINT JOSEPH MI
49085-3352
US

V. Phone/Fax

Practice location:
  • Phone: 269-428-3300
  • Fax: 269-428-5005
Mailing address:
  • Phone: 269-428-3300
  • Fax: 269-428-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number4301517153
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: