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NPI Code Detail

MEDICARE: DR. CHARLES R HARRISON MD

MEDICARE: DR. CHARLES R HARRISON MD
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
1207VX0201XGynecologic Oncology PhysicianCH070071MI

General Provider Information

NPI Number : 1245340223
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES R HARRISON MD
Provider Business Mailing Address
First Line : 100 MICHIGAN ST NE # MC845
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-2560
Country : US
Telephone Number : 616-486-6790
Fax Number :
Provider Business Practice Location Address
First Line : 145 MICHIGAN ST NE
Second Line : STE 6300
City : GRAND RAPIDS
State : MI
Zip : 49503-2562
Country : US
Telephone Number : 616-486-6000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 07/01/2021

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Directions to “ DR. CHARLES R HARRISON MD” Practice Location

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