Provider Demographics
NPI:1366511560
Name:HARRIS, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4100 PARK FOREST DR STE 200
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7306
Mailing Address - Country:US
Mailing Address - Phone:231-600-7466
Mailing Address - Fax:877-370-4631
Practice Address - Street 1:4100 PARK FOREST DR STE 200
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7306
Practice Address - Country:US
Practice Address - Phone:231-600-7466
Practice Address - Fax:877-370-4631
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2022-12-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301058808208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology