Provider Demographics
NPI:1558741686
Name:HALL, MICHELLE LYNNETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LYNNETTE
Last Name:HALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:410 LIONEL WAY FL 3
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-7809
Mailing Address - Country:US
Mailing Address - Phone:863-419-2420
Mailing Address - Fax:863-419-2475
Practice Address - Street 1:410 LIONEL WAY FL 3
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-7809
Practice Address - Country:US
Practice Address - Phone:863-419-2420
Practice Address - Fax:863-419-2475
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000000000000207Q00000X
FLME136536207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine