Provider Demographics
NPI:1164087839
Name:PRITCHETT, HARRY III
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:
Last Name:PRITCHETT
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16603 BRINGARD DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-1522
Mailing Address - Country:US
Mailing Address - Phone:586-843-5835
Mailing Address - Fax:
Practice Address - Street 1:16603 BRINGARD DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-1522
Practice Address - Country:US
Practice Address - Phone:586-843-5835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-07
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIP632298018770347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle