Provider Demographics
NPI:1457319832
Name:HALSEY, DAVID LEE (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
Last Name:HALSEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 GREENWOOD AVE
Mailing Address - Street 2:STE #6
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-3077
Mailing Address - Country:US
Mailing Address - Phone:517-787-2232
Mailing Address - Fax:517-784-9219
Practice Address - Street 1:1310 GREENWOOD AVE
Practice Address - Street 2:STE #6
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-3077
Practice Address - Country:US
Practice Address - Phone:517-787-2232
Practice Address - Fax:517-784-9219
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301049863207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI102657159Medicaid
MIN53130014OtherMEDICARE-WA FOOTE
MIB43427Medicare UPIN
MI102657159Medicaid