Provider Demographics
NPI:1467458257
Name:ANGELA L. HARRIS, M.D., P.C.
Entity Type:Organization
Organization Name:ANGELA L. HARRIS, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:LENELL
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-586-7400
Mailing Address - Street 1:PO BOX 21893
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-0893
Mailing Address - Country:US
Mailing Address - Phone:313-586-7400
Mailing Address - Fax:313-221-9124
Practice Address - Street 1:2950 W OUTER DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-1750
Practice Address - Country:US
Practice Address - Phone:313-586-7400
Practice Address - Fax:313-221-9124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-26
Last Update Date:2013-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058258207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080H237420OtherBCBSM
1363702OtherFIRST HEALTH PLAN
5717471OtherAETNA
211296OtherONE HEALTH PLAN/ GREAT-WEST HEALTHCARE
MI3395292Medicaid
MI080H237420OtherBCBSM
211296OtherONE HEALTH PLAN/ GREAT-WEST HEALTHCARE