MEDICARE: MAX HARRIS ENGELMAN OD

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	152W00000X	Optometrist	4901002958	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P50250001	OTHER	MI	MEDICARE WPS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	900B410480	OTHER	MI	BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730196262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAX HARRIS ENGELMAN OD

Provider Business Mailing Address
First Line	:	1323 SPRING ST
Second Line	:
City	:	PETOSKEY
State	:	MI
Zip	:	49770-8720
Country	:	US
Telephone Number	:	231-439-3937
Fax Number	:	231-439-9058

Provider Business Practice Location Address
First Line	:	1323 SPRING ST
Second Line	:
City	:	PETOSKEY
State	:	MI
Zip	:	49770-8720
Country	:	US
Telephone Number	:	231-439-3937
Fax Number	:	231-439-9058

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	05/06/2014

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Directions to “ MAX HARRIS ENGELMAN OD” Practice Location

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