Provider Demographics
NPI:1396981270
Name:DR. MICHAEL D. HARVEY, P.A.
Entity type:Organization
Organization Name:DR. MICHAEL D. HARVEY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-835-2425
Mailing Address - Street 1:212 15TH AVE NE
Mailing Address - Street 2:SUITE 1030
Mailing Address - City:WASECA
Mailing Address - State:MN
Mailing Address - Zip Code:56093-2778
Mailing Address - Country:US
Mailing Address - Phone:507-835-2425
Mailing Address - Fax:507-835-5818
Practice Address - Street 1:212 15TH AVE NE
Practice Address - Street 2:SUITE 1030
Practice Address - City:WASECA
Practice Address - State:MN
Practice Address - Zip Code:56093-2778
Practice Address - Country:US
Practice Address - Phone:507-835-2425
Practice Address - Fax:507-835-5818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-26
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN002430111NI0900X
MN001131111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN59582OtherMPIN
MN59582HAOtherBC/BS
MN605716100Medicaid
MNU30227Medicare UPIN
MN605716100Medicaid