Basic Information
| Provider Information | |||||||||
| NPI: | 1508974734 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRAEVE | ||||||||
| FirstName: | JANET | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1055 6TH AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503142607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5156438672 | ||||||||
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| Practice Location | |||||||||
| Address1: | 330 LAUREL ST | ||||||||
| Address2: | SUITE 2100 | ||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503143034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5156438611 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 25631 | IA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1273037 | 05 | IA | MEDICAID |