Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 4301080319 | MI |
N | 2080A0000X | Adolescent Medicine | 4301080319 | MI |
NPI | 1194787424 |
---|---|
Provider Name | Dr. Susan Louise Harris |
First Address | Ann Arbor, MI 48104-3203 |
Second Address | Ann Arbor, MI 48104-3203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2006 |
Last Update Date | 24/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
101377820 | (05) | MI |
F06422 | (02) | MI |