Provider Demographics
NPI:1477543346
Name:HARRISON, DUANE D (MD)
Entity Type:Individual
Prefix:DR
First Name:DUANE
Middle Name:D
Last Name:HARRISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 940
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48480
Mailing Address - Country:US
Mailing Address - Phone:888-477-1900
Mailing Address - Fax:810-603-7478
Practice Address - Street 1:1691 E. US 23
Practice Address - Street 2:SUITE 5
Practice Address - City:EAST TAWAS
Practice Address - State:MI
Practice Address - Zip Code:48730
Practice Address - Country:US
Practice Address - Phone:888-477-1900
Practice Address - Fax:810-603-7478
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301038250207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
N30990002Medicare ID - Type Unspecified
F10080Medicare UPIN