Provider Demographics
NPI:1073587176
Name:HARRISON, MARK E (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:HARRISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:620 N CARRIAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-4501
Mailing Address - Country:US
Mailing Address - Phone:316-962-3100
Mailing Address - Fax:316-962-3192
Practice Address - Street 1:620 N CARRIAGE PKWY
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4501
Practice Address - Country:US
Practice Address - Phone:316-962-3100
Practice Address - Fax:316-962-3192
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS0429569208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS102992OtherBCBS
KS100456510AMedicaid
KS102992OtherBCBS
H85838Medicare UPIN