Provider Demographics
NPI:1467527317
Name:HALLE, MICHAEL B (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:B
Last Name:HALLE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2101 EAST JEFFERSON STREET PPQA MEDICARE COMPLIANCE UNI
Mailing Address - Street 2:KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:
Practice Address - Street 1:2101 E JEFFERSON ST
Practice Address - Street 2:KAISER PERMANENTE SPRINGFIELD MEDICARE ENROLLMENT
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4908
Practice Address - Country:US
Practice Address - Phone:701-922-1000
Practice Address - Fax:703-922-1039
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2011-11-16
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Provider Licenses
StateLicense IDTaxonomies
VA0101048419207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F15779Medicare UPIN