Provider Demographics
NPI:1215964762
Name:HARRIS, MICHAEL LINDON (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LINDON
Last Name:HARRIS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:4501 MACCORKLE AVE SW
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1444
Mailing Address - Country:US
Mailing Address - Phone:304-766-6266
Mailing Address - Fax:304-766-7825
Practice Address - Street 1:4501 MACCORKLE AVE SW
Practice Address - Street 2:SUITE 500
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1444
Practice Address - Country:US
Practice Address - Phone:304-766-6266
Practice Address - Fax:304-766-7825
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV17469207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0095821000Medicaid
WV0741845Medicare ID - Type Unspecified
WV0095821000Medicaid