Provider Demographics
NPI:1205873882
Name:HARRIS, PAUL W (MD)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:W
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3267 S 16TH STREET
Mailing Address - Street 2:ROOM 200
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-4500
Mailing Address - Country:US
Mailing Address - Phone:414-389-3111
Mailing Address - Fax:414-389-3110
Practice Address - Street 1:3267 S 16TJ STREET
Practice Address - Street 2:ROOM 200
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4500
Practice Address - Country:US
Practice Address - Phone:414-389-3111
Practice Address - Fax:414-389-3110
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2010-11-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI461662084A0401X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34454900Medicaid
WI34454900Medicaid
WIH51980Medicare UPIN