Individual
TERRI L. HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2625 E 62ND STREET, STE 2010, INDIANAPOLIS, IN 46220-3191
(317) 251-6121
(317) 257-0390
Mailing address
250 N SHADELAND AVE, STE 130 PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01032792
IN
208000000X
Pediatrics Physician
01032792A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000086793
ANTHEM
IN
05
—
100226560
—
IN
Enumeration date
05/01/2006
Last updated
02/04/2014
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