Provider Demographics
NPI:1104057074
Name:HARVEY W. HALBERSTADT M.D. P.C.
Entity type:Organization
Organization Name:HARVEY W. HALBERSTADT M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:W
Authorized Official - Last Name:HALBERSTADT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-457-9667
Mailing Address - Street 1:575 E BIG BEAVER RD
Mailing Address - Street 2:STE. 360
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1300
Mailing Address - Country:US
Mailing Address - Phone:248-457-9667
Mailing Address - Fax:248-457-9666
Practice Address - Street 1:575 E BIG BEAVER RD
Practice Address - Street 2:STE. 360
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1300
Practice Address - Country:US
Practice Address - Phone:248-457-9667
Practice Address - Fax:248-457-9666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010277992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0633527Medicare PIN