Provider Demographics
NPI:1750787784
Name:HALO PRIMARY CARE PLLC
Entity type:Organization
Organization Name:HALO PRIMARY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHIR
Authorized Official - Middle Name:
Authorized Official - Last Name:ELDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-993-7777
Mailing Address - Street 1:4160 JOHN R ST
Mailing Address - Street 2:SUITE 510
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2020
Mailing Address - Country:US
Mailing Address - Phone:313-993-7777
Mailing Address - Fax:313-993-2563
Practice Address - Street 1:1535 E STATE FAIR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48203-1257
Practice Address - Country:US
Practice Address - Phone:313-891-2740
Practice Address - Fax:313-731-0213
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEART & VASCULAR INSTITUTE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care