Basic Information
| Provider Information | |||||||||
| NPI: | 1588705669 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROBERT GRAHAM PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17940 FARMINGTON RD | ||||||||
| Address2: | SUITE 225 | ||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481524444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344663311 | ||||||||
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| Practice Location | |||||||||
| Address1: | 17940 FARMINGTON RD | ||||||||
| Address2: | SUITE 225 | ||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481524444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344663311 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2007 | ||||||||
| LastUpdateDate: | 07/19/2012 | ||||||||
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| AuthorizedOfficialLastName: | GRAHAM | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | KEITH | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2488912242 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801015256 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.