Individual
HARRISON R PHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
W3985 COUNTY ROAD NN, ELKHORN, WI 53121-4337
(262) 741-2000
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5251
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100147837
—
WI
Enumeration date
08/31/2020
Last updated
02/13/2024
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