MEDICARE: BSMA HALLAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	372500000X	Chore Provider

General Provider Information

NPI Number	:	1184477390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BSMA HALLAM

Provider Business Mailing Address
First Line	:	1955 FRY RD
Second Line	:
City	:	BURT
State	:	MI
Zip	:	48417-9604
Country	:	US
Telephone Number	:	989-780-6758
Fax Number	:

Provider Business Practice Location Address
First Line	:	1955 FRY RD
Second Line	:
City	:	BURT
State	:	MI
Zip	:	48417-9604
Country	:	US
Telephone Number	:	989-780-6758
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2024
Last Update Date	:	04/08/2024

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Directions to “ BSMA HALLAM ” Practice Location

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