Basic Information
Provider Information
NPI: 1598221681
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HARIG
FirstName: JOHN
MiddleName: R
NamePrefix:  
NameSuffix: SR.
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6753 STATE RD
Address2:  
City: PARMA
State: OH
PostalCode: 441344517
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 812 BIRUTA ST
Address2:  
City: AKRON
State: OH
PostalCode: 443071104
CountryCode: US
TelephoneNumber: 3307622961
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/14/2019
LastUpdateDate: 02/14/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
175T00000X  Y    

No ID Information.


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