Individual
CHARLES R HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
509 N PERU ST, CICERO, IN 46034-9499
(317) 984-9311
(317) 984-7302
Mailing address
PO BOX 869, NOBLESVILLE, IN 46061-0869
(317) 770-6900
(317) 770-6911
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01035173A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000081519
ANTHEM
IN
05
—
100126140
—
IN
01
—
Q0085361
SHO
—
Enumeration date
12/28/2005
Last updated
05/28/2009
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