Provider Demographics
NPI:1235207416
Name:HARRIS, ANTHONY F (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:F
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19141 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-6007
Mailing Address - Country:US
Mailing Address - Phone:313-836-5801
Mailing Address - Fax:313-836-1144
Practice Address - Street 1:29201 TELEGRAPH RD STE 460
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-7604
Practice Address - Country:US
Practice Address - Phone:248-450-3507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301036406207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
104767OtherGREAT LAKES HEALTH PLAN
MI1368015Medicaid
1108249642OtherBCBS
130640OtherCARE CHOICES
1108249642OtherBCBS
A74047Medicare UPIN