Provider Demographics
NPI:1366493827
Name:HARRIS, MICHAEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3430 NEWBURG RD
Mailing Address - Street 2:STE 210
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-2458
Mailing Address - Country:US
Mailing Address - Phone:502-454-8800
Mailing Address - Fax:502-736-0124
Practice Address - Street 1:3430 NEWBURG RD
Practice Address - Street 2:SUITE 210
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-2497
Practice Address - Country:US
Practice Address - Phone:502-454-8800
Practice Address - Fax:502-736-0124
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2018-11-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY330062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00187918OtherRR MEDICARE
KY64050040Medicaid
KYP00187918OtherRR MEDICARE
KY0609903Medicare PIN
KYH35143Medicare UPIN