=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265608590
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRENDA L. HARSHMAN, DO, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2008
-----------------------------------------------------
Last Update Date | 05/06/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1426 N MCEWAN ST
-----------------------------------------------------
City | CLARE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48617-1114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-386-6188
-----------------------------------------------------
Fax | 989-386-9690
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1426 N MCEWAN ST
-----------------------------------------------------
City | CLARE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48617-1114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-386-6188
-----------------------------------------------------
Fax | 989-386-9690
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BRENDA L HARSHMAN
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 989-386-6188
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LH0002X
-----------------------------------------------------
Taxonomy Name | Hospice and Palliative Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | 5101010254
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------