DR. JEFFREY HALLADAY (NPI# 1326243544) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326243544 |
| Entity Type | Individual |
| Full Name | DR. JEFFREY HALLADAY |
| Credential | M.D. |
| Practice Address |
4646 John R St Detroit MI 48201-1916 |
| Mailing Address |
601 John St Ste M-124 Kalamazoo MI 49007-5341 |
| Practice Telephone | 3135761000 |
| Mailing Telephone | 2693417500 |
| Mailing Fax Number | 2693417540 |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2020-10-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
40163 | SC | Allopathic & Osteopathic Physicians |
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
4301099265 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | 401639 | 05 | |
| MN | ENROLLED | 05 | |
| MN | MEDICARE RAILROAD | P00804136 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 300 North Ave, Battle Creek, MI 490173307 | 2692455862 | |
| 601 John St Ste M-124, Kalamazoo, MI 490075377 | 2693417500 |
| Street Address |
4646 JOHN R ST |
| City | DETROIT |
| State | MI |
| Zip Code | 48201-1916 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356344121 | Christopher Emil Hermann | Nurse Practitioner | 4646 John R St, Detroit, MI 48201-1916 | 2005-05-24 |
| 1881293892 | Derrick Williams | Registered Nurse | 4646 John R St, Detroit, MI 48201-1916 | 2020-10-21 |
| 1598371544 | Sonia Govil | Dietitian, Registered | 4646 John R St, Detroit, MI 48201-1916 | 2020-09-16 |
| 1740893569 | Nicholas Edward Peters | Pharmacist | 4646 John R St, Detroit, MI 48201-1916 | 2020-08-31 |
| 1710597455 | Amber Michelle Young | Social Worker | 4646 John R St, Detroit, MI 48201-1916 | 2020-08-07 |
| 1104434471 | Zeinab H Moussa | Pharmacist | 4646 John R St, Detroit, MI 48201-1916 | 2020-07-22 |
| 1235747346 | Samantha Beth Lewis | Psychologist | 4646 John R St, Detroit, MI 48201-1916 | 2020-07-15 |
| 1477171189 | Rima Mohammad Fardos | Pharmacist | 4646 John R St, Detroit, MI 48201-1916 | 2020-07-09 |
| 1992323869 | Sarah F Waqhar | Student in an Organized Health Care Education/Training Program | 4646 John R St, Detroit, MI 48201-1916 | 2020-07-08 |
| 1619594181 | Mellisa Ann Boyle | Student in an Organized Health Care Education/Training Program | 4646 John R St, Detroit, MI 48201-1916 | 2020-07-01 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659989838 | Saima Sharif | Student in an Organized Health Care Education/Training Program | 4201 St Antoine St 9c-uhc Detroit Education & Research, Detroit, MI 48201 | 2020-07-14 |
| 1609494384 | Praveen Kumar Boddu | Student in an Organized Health Care Education/Training Program | 3901,beaubien, Ste 3t72, Children's Hospital, Detroit, MI 48201 | 2020-07-09 |
| 1730707720 | Amr Hassan Abdelghaffar Omar | Pediatrics | 3901 Beaubien St Room 3t72, Children's Hospital of Michigan, Detroit, MI 48201 | 2020-07-07 |
| 1700400694 | Hassan Imtiaz | Student in an Organized Health Care Education/Training Program | 4201 St. Antoine 8c-uhc, Detroit Medical Center, Detroit, MI 48201 | 2020-06-05 |
| 1598389074 | Alaa Awad Elkarim | Student in an Organized Health Care Education/Training Program | 3901 Beaubien St. 3t72, Detroit, MI 48201 | 2020-06-01 |
| 1891319299 | Jeongyeon Hwang | Student in an Organized Health Care Education/Training Program | 4201 St Antoine Street University Health Center - 8c, Detroit, MI 48201 | 2020-06-01 |
| 1477176576 | Jaudat Fatima Masood | Student in an Organized Health Care Education/Training Program | 4201 St Antoine Street, University Health Center - 8c, Detroit, MI 48201 | 2020-05-22 |
| 1205459419 | Amit Kumar Dahiya | Student in an Organized Health Care Education/Training Program | 11201 St. Antoine, Room 2e Uhc, Detroit, MI 48201 | 2020-05-21 |
| 1851914188 | Asra Nausheen Shaik | Student in an Organized Health Care Education/Training Program | 4201 St. Antoine St, Room 2e-uhc, Detroit, MI 48201 | 2020-05-21 |
| 1568085751 | Camille Olechowski | Student in an Organized Health Care Education/Training Program | 3901 Chrysler Dr. Detroit Medical Center, Room 5-a 538.1, Detroit, MI 48201 | 2020-05-21 |
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| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720636657 | Muhammad Irshad Khan | Psychiatry & Neurology | 4201 Saint Antoine St Ste Uhc -8d, Detroit, MI 48201-2153 | 2019-09-04 |
| 1508353145 | Kalyan Yarraguntla | Psychiatry & Neurology | 4201 Saint Antoine St # 8c, Detroit, MI 48201-2153 | 2018-04-19 |
| 1932573904 | Detroit Brain Institute Pllc | Psychiatry & Neurology | 18111 Wildemere St, Detroit, MI 48221-2728 | 2015-11-13 |
| 1497060818 | Anza Bilal Memon | Psychiatry & Neurology | 4201 Saint Antoine St Ste 8a, Detroit, MI 48201-2153 | 2010-08-10 |
| 1407167802 | Rahul Damani | Psychiatry & Neurology | 4201 Saint Antoine Street, Detroit, MI 48201 | 2010-06-30 |
| 1689805087 | Humaira Fahim | Psychiatry & Neurology | 4201 Saint Antoine St # St8a, Detroit, MI 48201-2153 | 2009-08-03 |
| 1235396607 | Elissa Kay Fory | Psychiatry & Neurology | 2799 W Grand Blvd # K-11, Detroit, MI 48202-2608 | 2008-05-21 |
| 1518188598 | Mary F Bridges | Psychiatry & Neurology | 8120 East Jefferson #3l, Detroit, MI 48214 | 2007-05-01 |
| 1881632511 | M Maher Fakhouri | Psychiatry & Neurology | 4201 Saint Antoine St Ste 8a&8b, University Health Center, Detroit, MI 48201-2153 | 2006-06-03 |
| 1255378774 | Edwin Black George | Psychiatry & Neurology | 4201 St Antoine Ste 8a & 8b, University Health Center, Detroit, MI 48201-2153 | 2006-06-01 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.