Healthcare Provider Details

I. General information

NPI: 1265608590
Provider Name (Legal Business Name): BRENDA L. HARSHMAN, DO, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1426 N MCEWAN ST
CLARE MI
48617-1114
US

IV. Provider business mailing address

1426 N MCEWAN ST
CLARE MI
48617-1114
US

V. Phone/Fax

Practice location:
  • Phone: 989-386-6188
  • Fax: 989-386-9690
Mailing address:
  • Phone: 989-386-6188
  • Fax: 989-386-9690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LH0002X
TaxonomyHospice and Palliative Medicine (Anesthesiology) Physician
License Number5101010254
License Number StateMI

VIII. Authorized Official

Name: BRENDA L HARSHMAN
Title or Position: OWNER
Credential: DO
Phone: 989-386-6188