Provider Demographics
NPI:1760675722
Name:FRANK G. HARRELL, M.D.
Entity Type:Organization
Organization Name:FRANK G. HARRELL, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:MORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-344-2694
Mailing Address - Street 1:1602 GULL RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1608
Mailing Address - Country:US
Mailing Address - Phone:269-344-2694
Mailing Address - Fax:269-344-9001
Practice Address - Street 1:1602 GULL RD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1608
Practice Address - Country:US
Practice Address - Phone:269-344-2694
Practice Address - Fax:269-344-9001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIFH020602207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1003704Medicaid
A77758Medicare UPIN