Provider Demographics
NPI: | 1265486591 |
---|---|
Name: | HARSCH, HAROLD H (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | HAROLD |
Middle Name: | H |
Last Name: | HARSCH |
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: | 1155 N MAYFAIR RD |
Mailing Address - Street 2: | DEPARTMENT OF PSYCHIATRY |
Mailing Address - City: | MILWAUKEE |
Mailing Address - State: | WI |
Mailing Address - Zip Code: | 53226-3462 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 414-955-8950 |
Mailing Address - Fax: | 414-955-6285 |
Practice Address - Street 1: | 1155 N MAYFAIR RD |
Practice Address - Street 2: | DEPARTMENT OF PSYCHIATRY |
Practice Address - City: | MILWAUKEE |
Practice Address - State: | WI |
Practice Address - Zip Code: | 53226-3462 |
Practice Address - Country: | US |
Practice Address - Phone: | 414-955-8950 |
Practice Address - Fax: | 414-955-6285 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-05-20 |
Last Update Date: | 2013-11-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WI | 24937 | 2084P0800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WI | 1265486591 | Medicaid | |
002000119Y | Other | HUMANA | |
WI | 0333 68-086 | Medicare PIN | |
WI | 0245 73-601 | Medicare PIN | |
WI | 1265486591 | Medicaid |