Individual
DR. TINA M HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
714 N SENATE AVE, STE EF205, INDIANAPOLIS, IN 46202-3763
(317) 715-6402
(317) 715-6415
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
01054487
IN
2085R0202X
Diagnostic Radiology Physician
Primary
01054487
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200351230
—
IN
01
—
P00176959
RAILROAD MEDICARE
IN
Enumeration date
06/14/2006
Last updated
02/01/2021
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