Provider Demographics
NPI:1659616431
Name:HARRIS, ANDREW BENJAMIN (CNIM)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:BENJAMIN
Last Name:HARRIS
Suffix:
Gender:M
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1945
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80901-1945
Mailing Address - Country:US
Mailing Address - Phone:719-888-1007
Mailing Address - Fax:719-487-2689
Practice Address - Street 1:816 N FOOTE AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-4508
Practice Address - Country:US
Practice Address - Phone:719-338-6715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1049246ZE0600X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology