Organization
CLINTON J HARRIS, MD, PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLINTON JACOB HARRIS M.D. (PRESIDENT)
(616) 949-4971
Entity
Organization
Contact information
Practice address
3600 E FULTON ST, GRAND RAPIDS, MI 49546-1322
(616) 949-4971
(616) 248-3530
Mailing address
3600 E FULTON, GRAND RAPIDS, MI 49546-1322
(616) 949-4971
(616) 248-3530
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
500D116030
BCBSM
MI
01
—
DA2804
RAILROAD MEDICARE
—
Enumeration date
03/09/2006
Last updated
09/19/2011
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