Provider Demographics
NPI:1275055626
Name:HARRIE, GHULAM A (MD)
Entity Type:Individual
Prefix:
First Name:GHULAM
Middle Name:A
Last Name:HARRIE
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 1:6150 CADIEUX RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-2006
Mailing Address - Country:US
Mailing Address - Phone:313-398-2800
Mailing Address - Fax:313-649-4855
Practice Address - Street 1:6150 CADIEUX RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-2006
Practice Address - Country:US
Practice Address - Phone:313-398-2800
Practice Address - Fax:313-649-4855
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301112847207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine