Basic Information
| Provider Information | |||||||||
| NPI: | 1063942340 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRAETER | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 86 W UNDERWOOD ST STE 202 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328061110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076496876 | ||||||||
| FaxNumber: | 4078720544 | ||||||||
| Practice Location | |||||||||
| Address1: | 2051 CLEVIDENCE BLVD STE C | ||||||||
| Address2: | |||||||||
| City: | CLARKSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471292278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122806623 | ||||||||
| FaxNumber: | 8126667688 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2017 | ||||||||
| LastUpdateDate: | 04/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 01084229A | IN | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.