Individual
BENNETT HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3365 S 103RD ST STE 210, MILWAUKEE, WI 53227-4161
(414) 228-4800
(262) 432-9004
Mailing address
3365 S 103RD ST STE 210, MILWAUKEE, WI 53227-4161
(414) 228-4800
(262) 432-9004
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
036.154123
IL
2084P0804X
Child & Adolescent Psychiatry Physician
34.014710
OH
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
74225
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1033596176
—
WI
Enumeration date
04/27/2015
Last updated
11/10/2020
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