Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 4301078629 | MI |
NPI | 1063521011 |
---|---|
Provider Name | Dr. William Carl Harris |
First Address | Lansing, MI 48909-8016 |
Second Address | Holland, MI 49423 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 23/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I05347 | (02) | |
P00267975 | RAILROAD MEDICARE (01) | MI |