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General NPI Number Information
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NPI Number | 1598197600
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Entity Type | Organization
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Legal Business Name | MY VISITING DOCTOR
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Dates
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Enumeration Date | 07/31/2013
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Last Update Date | 07/31/2013
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Provider Practice Location Address
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Address Line | 850 S HEWITT RD # 20
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City | YPSILANTI
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State | MI
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Zip | 48197-4594
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Country | US
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Telephone | 734-484-6423
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Fax | 313-429-7653
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Provider Business Mailing Address
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Address Line | 850 S HEWITT RD STE 20
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City | YPSILANTI
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State | MI
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Zip | 48197-4594
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Country | US
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Telephone | 734-484-6423
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Fax | 313-429-7653
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CLAUDE W HALL
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Credential | M.D.
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Telephone | 734-484-6423
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301041684
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License Number State | MI
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