Provider Demographics
NPI:1902859721
Name:HARRIS, KURT GENE (MD)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:GENE
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 S 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-1000
Mailing Address - Country:US
Mailing Address - Phone:920-746-9729
Mailing Address - Fax:920-746-9881
Practice Address - Street 1:228 S 18TH AVE
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-1000
Practice Address - Country:US
Practice Address - Phone:920-746-9729
Practice Address - Fax:920-746-9881
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI387632085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32318600Medicaid
WI32318600Medicaid