MEDICARE: DR. ANDRE TODD HARRIS SR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	35086818	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134192644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDRE TODD HARRIS SR. M.D.

Provider Business Mailing Address
First Line	:	1 ELIZABETH PL
Second Line	:	5TH FLOOR, STE. M
City	:	DAYTON
State	:	OH
Zip	:	45417-3445
Country	:	US
Telephone Number	:	937-228-4942
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 ELIZABETH PL
Second Line	:	5TH FLR, STE. M
City	:	DAYTON
State	:	OH
Zip	:	45417-3445
Country	:	US
Telephone Number	:	937-228-4942
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	06/08/2011

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