Provider Demographics
NPI:1619988839
Name:HALL, MAURICE ADAMS (MD)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:ADAMS
Last Name:HALL
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 1:3001 SEMINOLE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-4900
Mailing Address - Country:US
Mailing Address - Phone:313-924-4947
Mailing Address - Fax:
Practice Address - Street 1:20755 GREENFIELD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5403
Practice Address - Country:US
Practice Address - Phone:248-552-8100
Practice Address - Fax:248-552-5038
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010030653174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1080991Medicaid
MI0826177Medicare ID - Type Unspecified
MI1080991Medicaid