MEDICARE: MICHAEL R HARBUT M.D., M.P.H., F.C.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	MH0048645	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033100292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL R HARBUT M.D., M.P.H., F.C.C.

Provider Business Mailing Address
First Line	:	PO BOX 112
Second Line	:
City	:	JENISON
State	:	MI
Zip	:	49429-0112
Country	:	US
Telephone Number	:	231-652-2500
Fax Number	:	616-837-6031

Provider Business Practice Location Address
First Line	:	118 N WASHINGTON AVE
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48067-1751
Country	:	US
Telephone Number	:	248-547-9100
Fax Number	:	248-547-9336

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	12/10/2009

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