Provider Demographics
NPI:1487656567
Name:HARRISON, ANIL (MD)
Entity Type:Individual
Prefix:MR
First Name:ANIL
Middle Name:
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 1:1054 CENTER DR
Mailing Address - Street 2:STE 2
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-3851
Mailing Address - Country:US
Mailing Address - Phone:859-625-5242
Mailing Address - Fax:859-625-5279
Practice Address - Street 1:1054 CENTER DR
Practice Address - Street 2:STE 2
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3851
Practice Address - Country:US
Practice Address - Phone:859-625-5242
Practice Address - Fax:859-625-5279
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-02
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32105207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000069482OtherANTHEM BCBS
KY1487656567OtherNPI
KY64321052Medicaid
KY110192185OtherRAIL ROAD MEDICARE
KY110192185OtherRAIL ROAD MEDICARE
KYG64234Medicare UPIN