Healthcare Provider Details

I. General information

NPI: 1679951131
Provider Name (Legal Business Name): HALA NAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2015
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date: 12/28/2015
Reactivation Date: 01/19/2016

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE # A90
CLEVELAND OH
44195-0002
US

V. Phone/Fax

Practice location:
  • Phone: 248-885-4859
  • Fax:
Mailing address:
  • Phone: 248-885-4859
  • Fax: 313-745-4052

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 Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number35.144636
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: