Basic Information
| Provider Information | |||||||||
| NPI: | 1912951955 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRAF | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | |||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2331 PROGRESS ST | ||||||||
| Address2: | SUITE D | ||||||||
| City: | WEST BRANCH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486619384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893451184 | ||||||||
| FaxNumber: | 9893456944 | ||||||||
| Practice Location | |||||||||
| Address1: | 2331 PROGRESS ST | ||||||||
| Address2: | SUITE D | ||||||||
| City: | WEST BRANCH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486619384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893451184 | ||||||||
| FaxNumber: | 9893456944 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2006 | ||||||||
| LastUpdateDate: | 12/20/2007 | ||||||||
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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 | 363A00000X | 5601001373 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 5601001373 | 01 | MI | MI LICENSE | OTHER |