MEDICARE: DR. MICHAEL R HARRIS 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	2084P0800X	Psychiatry Physician	33006	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00187918	OTHER	KY	RR MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1366493827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL R HARRIS MD

Provider Business Mailing Address
First Line	:	3430 NEWBURG RD
Second Line	:	STE 210
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-2458
Country	:	US
Telephone Number	:	502-454-8800
Fax Number	:	502-736-0124

Provider Business Practice Location Address
First Line	:	3430 NEWBURG RD
Second Line	:	SUITE 210
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-2497
Country	:	US
Telephone Number	:	502-454-8800
Fax Number	:	502-736-0124

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	11/29/2018

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