Individual
ANDREW HALLETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4100 LAKE DR SE STE 205, GRAND RAPIDS, MI 49546-8292
(616) 267-7100
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
4301512108
MI
208600000X
Surgery Physician
Primary
9271076
ID
208600000X
Surgery Physician
MT213958
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/25/2016
Last updated
10/28/2025
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