Healthcare Provider Details

I. General information

NPI: 1699608992
Provider Name (Legal Business Name): BRIAN HARRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 JOHN ST
KALAMAZOO MI
49007-5232
US

IV. Provider business mailing address

6252 ANGLING RD
PORTAGE MI
49024-1055
US

V. Phone/Fax

Practice location:
  • Phone: 269-341-6386
  • Fax:
Mailing address:
  • Phone: 734-731-4774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704297188
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: