Healthcare Provider Details

I. General information

NPI: 1598682957
Provider Name (Legal Business Name): MYA HARRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LAKISHA HARRIS

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23077 GREENFIELD RD STE 420
SOUTHFIELD MI
48075-3748
US

IV. Provider business mailing address

23077 GREENFIELD RD STE 420
SOUTHFIELD MI
48075-3748
US

V. Phone/Fax

Practice location:
  • Phone: 734-489-1308
  • Fax:
Mailing address:
  • Phone: 734-489-1308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: