Provider Demographics
NPI:1245219161
Name:HARRISON, MICHAEL R (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:HARRISON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:520 MARY ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-1677
Mailing Address - Country:US
Mailing Address - Phone:812-452-3400
Mailing Address - Fax:812-452-3403
Practice Address - Street 1:520 MARY ST
Practice Address - Street 2:SUITE 230
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1677
Practice Address - Country:US
Practice Address - Phone:812-452-3400
Practice Address - Fax:812-452-3403
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2011-07-20
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Provider Licenses
StateLicense IDTaxonomies
IN01039589207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100343880Medicaid
192670AMedicare PIN
IN100343880Medicaid