Basic Information
| Provider Information | |||||||||
| NPI: | 1487698981 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARRAH | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7 INDEPENDENCE PT | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296154566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8647976044 | ||||||||
| FaxNumber: | 8647976195 | ||||||||
| Practice Location | |||||||||
| Address1: | 2A CLEVELAND CT | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296072414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642717761 | ||||||||
| FaxNumber: | 8642352045 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 05/20/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 7105 | SC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 071059 | 05 | SC | MEDICAID | 1552936 | 01 | SC | CIGNA | OTHER | 4241018 | 01 | SC | AETNA | OTHER | 080089700 | 01 | SC | RR MEDICARE | OTHER | 571004971011 | 01 | SC | BCBS OF SC | OTHER |