Provider Demographics
NPI:1457465213
Name:HARRIS, SEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SEAN
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:23077 GREENFIELD RD
Mailing Address - Street 2:SUITE 195
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3709
Mailing Address - Country:US
Mailing Address - Phone:248-423-0700
Mailing Address - Fax:248-423-0707
Practice Address - Street 1:23077 GREENFIELD RD
Practice Address - Street 2:SUITE 195
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3710
Practice Address - Country:US
Practice Address - Phone:248-423-0700
Practice Address - Fax:248-423-0707
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301078539207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI45051470-10Medicaid
MIH45172Medicare UPIN
MI0N71120003Medicare ID - Type Unspecified