=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154493971
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBBIE HAYMOWATTEE HALLAK DO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2006
-----------------------------------------------------
Last Update Date | 10/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 616 MEIJER ST
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-543-7800
-----------------------------------------------------
Fax | 517-543-7900
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 327
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-543-7800
-----------------------------------------------------
Fax | 517-543-7900
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 5101012000
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 510101200
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------