Provider Demographics
NPI:1609975655
Name:HALAT, ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:HALAT
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 1:2629 OAK CREEK DR
Mailing Address - Street 2:
Mailing Address - City:COPPEROPOLIS
Mailing Address - State:CA
Mailing Address - Zip Code:95228-9478
Mailing Address - Country:US
Mailing Address - Phone:209-754-2602
Mailing Address - Fax:209-785-7025
Practice Address - Street 1:768 MOUNTAIN RANCH RD
Practice Address - Street 2:
Practice Address - City:SAN ANDREAS
Practice Address - State:CA
Practice Address - Zip Code:95249-9707
Practice Address - Country:US
Practice Address - Phone:209-754-2602
Practice Address - Fax:209-785-7025
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53251207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4250262Medicaid
MIA74915Medicare UPIN
MI0N18900Medicare ID - Type Unspecified