Provider Demographics
NPI:1578678728
Name:KO, HARRY SEUNG-SHIK (DO)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:SEUNG-SHIK
Last Name:KO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 AIRPORT ACCESS RD
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3513
Mailing Address - Country:US
Mailing Address - Phone:231-922-8282
Mailing Address - Fax:
Practice Address - Street 1:1175 AIRPORT ACCESS RD
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3513
Practice Address - Country:US
Practice Address - Phone:231-922-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5605207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD9958Medicaid
AK8EB889Medicare ID - Type Unspecified
AKI36901Medicare UPIN