Provider Demographics
NPI:1760448237
Name:HARSH, LAURI ANN (DO)
Entity Type:Individual
Prefix:
First Name:LAURI
Middle Name:ANN
Last Name:HARSH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3400 DEXTER CT
Mailing Address - Street 2:SUITE 116
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3461
Mailing Address - Country:US
Mailing Address - Phone:563-355-7602
Mailing Address - Fax:563-355-7606
Practice Address - Street 1:3400 DEXTER CT
Practice Address - Street 2:SUITE 116
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3461
Practice Address - Country:US
Practice Address - Phone:563-355-7602
Practice Address - Fax:563-355-7606
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA3533207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0701252Medicaid
IA1306055OtherCSA
BH8567488OtherDEA
IA1306055OtherCSA
H99358Medicare UPIN