Provider Demographics
NPI:1053664672
Name:CLAUDE W. HALL M.D. P.C.
Entity Type:Organization
Organization Name:CLAUDE W. HALL M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:W
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-743-8454
Mailing Address - Street 1:2442 E MAPLE AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-4462
Mailing Address - Country:US
Mailing Address - Phone:810-743-8454
Mailing Address - Fax:
Practice Address - Street 1:2442 E MAPLE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-4462
Practice Address - Country:US
Practice Address - Phone:810-743-8454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLAUDE W. HALL, M.D. P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-19
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301041684208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI6297Medicare PIN