Healthcare Provider Details

I. General information

NPI: 1497758205
Provider Name (Legal Business Name): MICAH STEPHEN HARRIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7342 E THOMAS RD STE 105
SCOTTSDALE AZ
85251-7243
US

IV. Provider business mailing address

PO BOX 6730
CHANDLER AZ
85246-6730
US

V. Phone/Fax

Practice location:
  • Phone: 480-821-3600
  • Fax: 480-857-2667
Mailing address:
  • Phone: 480-821-3600
  • Fax: 480-857-2667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number21602
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: