Provider Demographics
NPI:1447352182
Name:HALBOTH, FREMONT D (MD)
Entity type:Individual
Prefix:DR
First Name:FREMONT
Middle Name:D
Last Name:HALBOTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1096 S BELSAY RD
Mailing Address - Street 2:STE F
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-1948
Mailing Address - Country:US
Mailing Address - Phone:810-742-9170
Mailing Address - Fax:810-742-7150
Practice Address - Street 1:1096 S BELSAY RD
Practice Address - Street 2:SUITE F
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1948
Practice Address - Country:US
Practice Address - Phone:810-742-9170
Practice Address - Fax:810-742-7150
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2011-11-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301046793207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3235691Medicaid
MIM23560030Medicare PIN
MI3235691Medicaid