MEDICARE: DR. ROGER STANLEY HARRIS D.O.

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	5101007120	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730188269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER STANLEY HARRIS D.O.

Provider Business Mailing Address
First Line	:	39880 VAN DYKE AVE STE 202
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48313-4670
Country	:	US
Telephone Number	:	586-264-7930
Fax Number	:	586-264-7931

Provider Business Practice Location Address
First Line	:	39880 VAN DYKE AVE STE 202
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48313-4670
Country	:	US
Telephone Number	:	586-264-7930
Fax Number	:	586-264-7931

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	04/23/2018

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