MEDICARE: GENA L HARRISON MD

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	207Q00000X	Family Medicine Physician	4301099427	MI

General Provider Information

NPI Number	:	1346532280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENA L HARRISON MD

Provider Business Mailing Address
First Line	:	26901 BEAUMONT BLVD STE 3D
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48033-3849
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14001 GREENFIELD RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48227-2101
Country	:	US
Telephone Number	:	313-273-1200
Fax Number	:	313-273-8130

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

Provider Enumeration Date	:	05/11/2011
Last Update Date	:	11/17/2020

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