Provider Demographics
NPI:1003850702
Name:MCCOY, HARRY JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:JAMES
Last Name:MCCOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1540 LAKE LANSING RD
Mailing Address - Street 2:STE 201
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3756
Mailing Address - Country:US
Mailing Address - Phone:517-913-3900
Mailing Address - Fax:517-913-3901
Practice Address - Street 1:1540 LAKE LANSING RD
Practice Address - Street 2:STE 201
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3756
Practice Address - Country:US
Practice Address - Phone:517-913-3900
Practice Address - Fax:517-913-3901
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301028154207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4853928Medicaid
MI1000923OtherMCLAREN HEALTH PLAN-MEDICAID
MI200000002370OtherPHP FAMILYCARE
MI110148963OtherRAILROAD MEDICARE
MI4083600Medicaid
MI1000923OtherMCLAREN HEALTH PLAN-COMMERCIAL
MI0M21440001OtherMEDICARE ADVANTAGE
MI1000923OtherMCLAREN HEALTH ADVANTAGE
MI1103354541OtherBCBS/BCN
MI200000002370OtherPHP
MI4452570OtherAETNA
MIA77928Medicare UPIN
MIM21440001Medicare PIN