Provider Demographics
NPI:1437272036
Name:JOEL J. HARRIS, D. O. P. C.
Entity Type:Organization
Organization Name:JOEL J. HARRIS, D. O. P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:D O
Authorized Official - Phone:245-541-1532
Mailing Address - Street 1:27301 DEQUINDRE RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-3473
Mailing Address - Country:US
Mailing Address - Phone:248-541-1532
Mailing Address - Fax:
Practice Address - Street 1:27301 DEQUINDRE RD
Practice Address - Street 2:SUITE 209
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3473
Practice Address - Country:US
Practice Address - Phone:248-541-1532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJH006452207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5630132Medicare ID - Type Unspecified
MIP464445Medicare UPIN