Provider Demographics
NPI:1982607347
Name:HARRIS, MALATI (MD)
Entity Type:Individual
Prefix:
First Name:MALATI
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 BILTMORE DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-1995
Mailing Address - Country:US
Mailing Address - Phone:785-331-1700
Mailing Address - Fax:785-331-1799
Practice Address - Street 1:1220 BILTMORE DR
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-1995
Practice Address - Country:US
Practice Address - Phone:785-505-2626
Practice Address - Fax:785-505-5333
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0427782207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200266060AMedicaid
KS103852Medicare PIN
KSI13163Medicare UPIN