Individual
STEPHEN D HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
3260 EAGLE PARK DR NE, SUITE 116, GRAND RAPIDS, MI 49525-4569
(616) 957-2088
(855) 665-5636
Mailing address
PO BOX 4839, TROY, MI 48099-4839
(248) 824-6600
(248) 324-1477
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
5901001348
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4348724
—
MI
01
—
4853950100
BLUE CROSS BLUE SHIELD #
MI
01
—
P00019530
MEDICARE RAILROAD
MI
Enumeration date
06/21/2005
Last updated
11/10/2011
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