Provider Demographics
NPI:1477655330
Name:HALUB, MARTHA F (PA)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:F
Last Name:HALUB
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1847
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1847
Mailing Address - Country:US
Mailing Address - Phone:231-727-4444
Mailing Address - Fax:231-728-4789
Practice Address - Street 1:6401 PRAIRIE ST
Practice Address - Street 2:SUITE 2100
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-7840
Practice Address - Country:US
Practice Address - Phone:231-727-7939
Practice Address - Fax:231-727-7935
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2012-11-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601001048363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIR79124Medicare UPIN