Provider Demographics
NPI:1346278108
Name:HARRISON, MARK S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:HARRISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:31 N SAINT JOSEPH AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-2207
Mailing Address - Country:US
Mailing Address - Phone:269-982-4862
Mailing Address - Fax:269-985-4523
Practice Address - Street 1:1234 NAPIER AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2112
Practice Address - Country:US
Practice Address - Phone:269-471-1700
Practice Address - Fax:269-471-1975
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301407295207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1538397120OtherGROUP NPI
MI76-30001OtherPHP
MI4382664Medicaid
MI1101120021OtherBLUE CROSS
MI110089873OtherRAILROAD MEDICARE
MI2427250OtherCIGNA
MI27-0381199OtherGROUP TAX ID
MI27-0381199OtherGROUP TAX ID
MI76-30001OtherPHP
MI4382664Medicaid