Provider Demographics
NPI:1669678587
Name:KENNETH A. HARRIS, M.D., P.C.
Entity Type:Organization
Organization Name:KENNETH A. HARRIS, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHANAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-974-6611
Mailing Address - Street 1:10503 W THUNDERBIRD BLVD
Mailing Address - Street 2:# 313
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3022
Mailing Address - Country:US
Mailing Address - Phone:623-933-3865
Mailing Address - Fax:623-933-1413
Practice Address - Street 1:10503 W THUNDERBIRD BLVD
Practice Address - Street 2:# 313
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3022
Practice Address - Country:US
Practice Address - Phone:623-933-3865
Practice Address - Fax:623-933-1413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ134812084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1215067533OtherINDIVIDUAL NPI
AZD44017Medicare UPIN
AZ1215067533OtherINDIVIDUAL NPI