Healthcare Provider Details

I. General information

NPI: 1619988839
Provider Name (Legal Business Name): MAURICE ADAMS HALL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20755 GREENFIELD RD SUITE 100
SOUTHFIELD MI
48075-5403
US

IV. Provider business mailing address

3001 SEMINOLE ST
DETROIT MI
48214-4900
US

V. Phone/Fax

Practice location:
  • Phone: 248-552-8100
  • Fax: 248-552-5038
Mailing address:
  • Phone: 313-924-4947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number43010030653
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: