MEDICARE: DR. MICAH STEPHEN 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	207V00000X	Obstetrics & Gynecology Physician	21602	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CB2763	OTHER	AZ	MEDICARE RAILROAD GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	142795	OTHER	AZ	AHCCCS IDENTIFIER

General Provider Information

NPI Number	:	1497758205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICAH STEPHEN HARRIS MD

Provider Business Mailing Address
First Line	:	PO BOX 6730
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85246-6730
Country	:	US
Telephone Number	:	480-821-3600
Fax Number	:	480-857-2667

Provider Business Practice Location Address
First Line	:	7342 E THOMAS RD STE 105
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-7243
Country	:	US
Telephone Number	:	480-821-3600
Fax Number	:	480-857-2667

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	11/22/2023

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