Provider Demographics
NPI:1265608590
Name:BRENDA L. HARSHMAN, DO, PC
Entity type:Organization
Organization Name:BRENDA L. HARSHMAN, DO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARSHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-386-6188
Mailing Address - Street 1:1426 N MCEWAN ST
Mailing Address - Street 2:
Mailing Address - City:CLARE
Mailing Address - State:MI
Mailing Address - Zip Code:48617-1114
Mailing Address - Country:US
Mailing Address - Phone:989-386-6188
Mailing Address - Fax:989-386-9690
Practice Address - Street 1:1426 N MCEWAN ST
Practice Address - Street 2:
Practice Address - City:CLARE
Practice Address - State:MI
Practice Address - Zip Code:48617-1114
Practice Address - Country:US
Practice Address - Phone:989-386-6188
Practice Address - Fax:989-386-9690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010254207LH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LH0002XAllopathic & Osteopathic PhysiciansAnesthesiologyHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114096037Medicaid
MIF35069Medicare UPIN
MIOM80640Medicare PIN