Provider Demographics
NPI:1235301201
Name:HARRIS, JANE K (DO)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:K
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 PETOSKEY ST
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2618
Mailing Address - Country:US
Mailing Address - Phone:231-439-3989
Mailing Address - Fax:231-348-8601
Practice Address - Street 1:424 PETOSKEY ST
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2618
Practice Address - Country:US
Practice Address - Phone:231-439-3989
Practice Address - Fax:231-348-8601
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-30
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008595207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI3086001Medicare PIN