MEDICARE: DR. STACY H HARR M.D.

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	208000000X	Pediatrics Physician	036130580	IL
2	208000000X	Pediatrics Physician	35.124213	OH

General Provider Information

NPI Number	:	1265669105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACY H HARR M.D.

Provider Business Mailing Address
First Line	:	3846 SULPHUR SPRING RD
Second Line	:
City	:	OTTAWA HILLS
State	:	OH
Zip	:	43606-2324
Country	:	US
Telephone Number	:	419-787-4101
Fax Number	:

Provider Business Practice Location Address
First Line	:	3846 SULPHUR SPRING RD
Second Line	:
City	:	OTTAWA HILLS
State	:	OH
Zip	:	43606-2324
Country	:	US
Telephone Number	:	419-787-4101
Fax Number	:

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

Provider Enumeration Date	:	06/18/2009
Last Update Date	:	11/03/2023

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