| Halo Medical Group Pllc | |
|
4160 John R St Ste 510 Detroit MI 48201 | |
| (313) 993-7777 | |
| (313) 993-2563 |
| Full Name | Halo Medical Group Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4160 John R St Ste 510, Detroit, Michigan |
| Authorized Official Name and Position | Mahir D Elder (PRESIDENT) |
| Authorized Official Contact | 3139937777 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Halo Medical Group Pllc 22720 Michigan Ave Ste 200 Dearborn MI 48124-2021 Ph: (313) 791-3000 | Halo Medical Group Pllc 4160 John R St Ste 510 Detroit MI 48201 Ph: (313) 993-7777 |
| NPI Number | 1811214489 |
|---|---|
| Provider Enumeration Date | 04/22/2010 |
| Last Update Date | 07/27/2018 |
| Medicare PECOS PAC ID | 1850587890 |
|---|---|
| Medicare Enrollment ID | O20101202000201 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811214489 | NPI | - | NPPES |
| 105174942 | Medicaid | MI | |
| I60238 | Other | MI | UPIN |
| Provider Name | Mansoor G Naini |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1780645036 PECOS PAC ID: 8628013679 Enrollment ID: I20050621000922 |
| Provider Name | Ashok K Kondur |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1508819434 PECOS PAC ID: 4880668326 Enrollment ID: I20050919001036 |
| Provider Name | Tracy J Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932149838 PECOS PAC ID: 0749292118 Enrollment ID: I20060629000239 |
| Provider Name | Keith Angelo Johnstone |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1760466049 PECOS PAC ID: 1850395500 Enrollment ID: I20060912000020 |
| Provider Name | Mahir D Elder |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1962427260 PECOS PAC ID: 5991701179 Enrollment ID: I20061011000303 |
| Provider Name | Nenad Serafimovski |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1093927972 PECOS PAC ID: 6305917899 Enrollment ID: I20080610000830 |
| Provider Name | Amir Kaki |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1831154798 PECOS PAC ID: 2961451687 Enrollment ID: I20110408000564 |
| Provider Name | Tamam Mohamad |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1457687584 PECOS PAC ID: 2062696321 Enrollment ID: I20110411000561 |
| Provider Name | Hassan Ismail |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1881687861 PECOS PAC ID: 6103837984 Enrollment ID: I20111215000876 |
| Provider Name | Mazhar Hasan Khan |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1437462579 PECOS PAC ID: 0143122317 Enrollment ID: I20120606000262 |
| Provider Name | Michael Ducato |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265743272 PECOS PAC ID: 5991939746 Enrollment ID: I20131009001495 |
| Provider Name | Ribhi Hazin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1265747463 PECOS PAC ID: 6901038140 Enrollment ID: I20140422001446 |
| Provider Name | Prasad K Cherian |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1144341645 PECOS PAC ID: 3577782648 Enrollment ID: I20140923000487 |
| Provider Name | Joya Ganguly |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1043473382 PECOS PAC ID: 3274711510 Enrollment ID: I20140925001674 |
| Provider Name | Tonia Anitra Willis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912263914 PECOS PAC ID: 7618291212 Enrollment ID: I20150129001864 |
| Provider Name | Deborah L Harris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124454954 PECOS PAC ID: 0143544718 Enrollment ID: I20150130001760 |
| Provider Name | Courtney Fletcher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881916435 PECOS PAC ID: 8022333293 Enrollment ID: I20150210001386 |
| Provider Name | Maha N Abu-khdeir |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1831383488 PECOS PAC ID: 0840511622 Enrollment ID: I20150604002218 |
| Provider Name | Redwan Asbahi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730445503 PECOS PAC ID: 5395050199 Enrollment ID: I20150821013669 |
| Provider Name | Nimrod Blank |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1255709218 PECOS PAC ID: 2365705787 Enrollment ID: I20180418001429 |
| Provider Name | Sablaa Ali |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1548500333 PECOS PAC ID: 1951653708 Enrollment ID: I20181006000169 |
| Provider Name | Nichole Fuller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720584899 PECOS PAC ID: 5597190447 Enrollment ID: I20200122003168 |
| Provider Name | Lena Hussein Mathena |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417597279 PECOS PAC ID: 6709215122 Enrollment ID: I20200407000994 |
| Provider Name | Bassel Hassouna |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1780918946 PECOS PAC ID: 9436569274 Enrollment ID: I20201105000599 |
| Provider Name | Marvin L Kajy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346774981 PECOS PAC ID: 1254609431 Enrollment ID: I20211216000431 |
| Provider Name | Ali S Huda |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1861848533 PECOS PAC ID: 7719342211 Enrollment ID: I20230507000073 |
| Provider Name | Olufolahan R Carrena |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1922478841 PECOS PAC ID: 2062740459 Enrollment ID: I20230802001082 |
| Provider Name | Jazmine Randolph |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487355087 PECOS PAC ID: 6507229184 Enrollment ID: I20230830000572 |
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