Organization
HALO PRIMARY CARE
Active
Parent organization
HALO MEDICAL GROUP PLLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
HALO MEDICAL GROUP PLLC
Authorized official
HANADY BEYDOUN (OFFICE MANAGER)
(313) 993-7777
Entity
Organization
Contact information
Practice address
1535 E STATE FAIR, DETROIT, MI 48203-1257
(313) 891-2740
Mailing address
22720 MICHIGAN AVE STE 200, DEARBORN, MI 48124-2021
(313) 891-2740
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12715957
CAQH
—
05
—
1417245721
—
MI
01
—
14264493
CAQH
—
Enumeration date
02/27/2019
Last updated
03/05/2019
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