Organization
HEART AND VASCULAR INSTITUTE
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
22720 MICHIGAN AVE STE 200, DEARBORN, MI 48124-2021
(313) 791-3000
Mailing address
22720 MICHIGAN AVE STE 200, DEARBORN, MI 48124-2021
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207RC0001X
Clinical Cardiac Electrophysiology Physician
—
—
363AM0700X
Medical Physician Assistant
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1043473382
—
MI
05
—
1144341645
—
MI
01
—
11615581
CAQH
—
01
—
11892261
CAQH
—
01
—
12063174
CAQH
—
01
—
12091363
CAQH
—
01
—
12151256
CAQH
—
01
—
12248863
CAQH
—
01
—
12345659
CAQH
—
01
—
12440670
CAQH
—
01
—
12718965
CAQH
—
05
—
1326291428
—
MI
05
—
1417010315
—
MI
01
—
14396095
CAQH
—
05
—
1457687584
—
MI
05
—
1831154798
—
MI
05
—
1881916435
—
MI
05
—
1912263914
—
MI
05
—
1932149838
—
MI
05
—
1962427260
—
MI
Enumeration date
02/27/2019
Last updated
02/27/2019
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