Provider Demographics
NPI:1902860661
Name:HARRELL, DAVID D (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:D
Last Name:HARRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1761 W M-43 HWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-8378
Mailing Address - Country:US
Mailing Address - Phone:269-945-3888
Mailing Address - Fax:269-945-2112
Practice Address - Street 1:1761 W M-43 HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-8378
Practice Address - Country:US
Practice Address - Phone:269-945-3888
Practice Address - Fax:269-945-2112
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI068813207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3272766Medicaid
MIP04740003Medicare ID - Type Unspecified
MI3272766Medicaid