Individual
MICHAEL DEBRE' HARRISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
435 CHERRY ST SE, GRAND RAPIDS, MI 49503-4672
(616) 776-0016
(616) 776-0275
Mailing address
435 CHERRY ST SE, GRAND RAPIDS, MI 49503-4672
(616) 776-0016
(616) 776-0275
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
4301061087
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0413654
BLUE CROSS BLUE SHIELD
MI
01
—
1005577
KENT HEALTH PLAN
MI
05
—
2973533
—
MI
Enumeration date
11/07/2006
Last updated
07/08/2007
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