Provider Demographics
NPI:1003807157
Name:HARRISON, MURKE FRANKLIN (DO LTD)
Entity Type:Individual
Prefix:DR
First Name:MURKE
Middle Name:FRANKLIN
Last Name:HARRISON
Suffix:
Gender:M
Credentials:DO LTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 767
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-0015
Mailing Address - Country:US
Mailing Address - Phone:618-244-2000
Mailing Address - Fax:618-244-6625
Practice Address - Street 1:2712 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-2342
Practice Address - Country:US
Practice Address - Phone:618-244-2000
Practice Address - Fax:618-244-6625
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036076625207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036076625Medicaid
IL04122575OtherBCBS
IL04122575OtherBCBS
E47438Medicare UPIN