Healthcare Provider Details

I. General information

NPI: 1518905330
Provider Name (Legal Business Name): MICHAEL BENJAMIN HALLET M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5141 W BROAD ST SUITE 180
COLUMBUS OH
43228-1992
US

IV. Provider business mailing address

5400 FRANTZ RD STE 250
DUBLIN OH
43016-6102
US

V. Phone/Fax

Practice location:
  • Phone: 614-544-1460
  • Fax: 614-544-1853
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number35044295
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: