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NPI Code Detail

MEDICARE: DWAYNE HARRIS

MEDICARE: DWAYNE HARRIS
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
1247200000XOther Technician

General Provider Information

NPI Number : 1275983405
Entity Type Code : Individual
Provider Name (Legal Business Name) : DWAYNE HARRIS
Provider Business Mailing Address
First Line : 8561 KENWOOD ST
Second Line :
City : OAK PARK
State : MI
Zip : 48237-2344
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8561 KENWOOD ST
Second Line :
City : OAK PARK
State : MI
Zip : 48237-2344
Country : US
Telephone Number : 248-797-6738
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2016
Last Update Date : 06/19/2016

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Directions to “ DWAYNE HARRIS ” Practice Location

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