Provider Demographics
NPI:1558684282
Name:JANE K HARRIS D O PLC
Entity Type:Organization
Organization Name:JANE K HARRIS D O PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C E O
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:K
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:D O
Authorized Official - Phone:231-348-8600
Mailing Address - Street 1:424 PETOSKEY ST
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2618
Mailing Address - Country:US
Mailing Address - Phone:231-348-8600
Mailing Address - Fax:231-348-8601
Practice Address - Street 1:424 PETOSKEY ST
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2618
Practice Address - Country:US
Practice Address - Phone:231-348-8600
Practice Address - Fax:231-348-8601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008595171100000X, 204D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI306Medicare PIN