Basic Information
| Provider Information | |||||||||
| NPI: | 1497749477 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRAVES | ||||||||
| FirstName: | ALECIA | ||||||||
| MiddleName: | ELLEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 4123 DUTCHMANS LANE | ||||||||
| Address2: | SUITE 507 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024239595 | ||||||||
| FaxNumber: | 5027190161 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2005 | ||||||||
| LastUpdateDate: | 01/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 31847 | KY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 000057120P | 01 | KY | HUMANA - WS | OTHER | 5002880 | 01 | KY | MEDICAID PASSPORT | OTHER | 65925109 | 01 | KY | MEDICAID GRP | OTHER | 8382591 | 01 | KY | CIGNA-WS | OTHER | 000000724240 | 01 | KY | ANTHEM - WS | OTHER | 1166219 | 01 | KY | GROUP MEDICAID PASSPORT | OTHER | 50034482 | 01 | KY | PASSPORT - WS | OTHER | 1052052 | 01 | KY | PASSPORT | OTHER | 127014 | 01 | KY | SIHO - WS | OTHER | 5581 | 01 | KY | MEDICARE GRP | OTHER | 64318470 | 05 | KY | MEDICAID |