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NPI Code Detail

MEDICARE: KELLY HARRIS

MEDICARE: KELLY 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 TechnicianH620465067432MI

General Provider Information

NPI Number : 1801331715
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY HARRIS
Provider Business Mailing Address
First Line : 9266 LOUIS
Second Line :
City : DETROIT
State : MI
Zip : 48239-1732
Country : US
Telephone Number : 313-318-3223
Fax Number :
Provider Business Practice Location Address
First Line : 9266 LOUIS
Second Line :
City : REDFORD
State : MI
Zip : 48239-1732
Country : US
Telephone Number : 313-318-3223
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/01/2017
Last Update Date : 01/01/2017

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Directions to “ KELLY HARRIS ” Practice Location

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