Individual
DR. MARY C HALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
500 CAMPUS DR, HANCOCK, MI 49930-1569
(906) 483-1730
(906) 483-1380
Mailing address
500 CAMPUS DR, HANCOCK, MI 49930-1569
(906) 483-1730
(906) 483-1380
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
MI43048076
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0829560001
MEDICARE DME
MI
01
—
0C16002
MEDICARE GROUP
—
05
—
102928716
—
MI
01
—
MH048076
BLUECROSS STATE ID
MI
Enumeration date
05/19/2006
Last updated
11/23/2009
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