Healthcare Provider Details

I. General information

NPI: 1467445411
Provider Name (Legal Business Name): BRENDA LYNN HARSHMAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 07/09/2007
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 Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101010254
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: