Basic Information
| Provider Information | |||||||||
| NPI: | 1831341536 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GRAHAM FAMILY MEDICINE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4501 W DEYOUNG ST | ||||||||
| Address2: | SUITE 107B | ||||||||
| City: | MARION | ||||||||
| State: | IL | ||||||||
| PostalCode: | 629596360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6189989200 | ||||||||
| FaxNumber: | 6189989700 | ||||||||
| Practice Location | |||||||||
| Address1: | 4501 W DEYOUNG ST | ||||||||
| Address2: | SUITE 107B | ||||||||
| City: | MARION | ||||||||
| State: | IL | ||||||||
| PostalCode: | 629596360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6189989200 | ||||||||
| FaxNumber: | 6189989700 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2008 | ||||||||
| LastUpdateDate: | 10/14/2008 | ||||||||
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| AuthorizedOfficialLastName: | GRAHAM | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 6189989200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.