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General NPI Number Information
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NPI Number | 1598760001
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Entity Type | Individual
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Provider Name | STEPHEN D HARRIS D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 06/21/2005
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Last Update Date | 11/10/2011
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Provider Practice Location Address
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Address Line | 3260 EAGLE PARK DR NE SUITE 116
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-4569
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Country | US
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Telephone | 616-957-2088
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Fax | 855-665-5636
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Provider Business Mailing Address
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Address Line | PO BOX 4839
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City | TROY
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State | MI
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Zip | 48099-4839
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Country | US
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Telephone | 248-824-6600
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Fax | 248-324-1477
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 5901001348
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License Number State | MI
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