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NPI Code Detail

MEDICARE: DR. JACK GRAHAM

MEDICARE: DR. JACK GRAHAM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician23856NH
2207P00000XEmergency Medicine Physician35.146959OH

General Provider Information

NPI Number : 1306406863
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACK GRAHAM
Provider Business Mailing Address
First Line : 9500 EUCLID AVE
Second Line : DEPARTMENT OF EMERGENCY SERVICES
City : CLEVELAND
State : OH
Zip : 44195-0001
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9500 EUCLID AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44195-0001
Country : US
Telephone Number : 216-445-4500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2019
Last Update Date : 12/22/2025

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Directions to “ DR. JACK GRAHAM ” Practice Location

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