MEDICARE: MARY L GRAEFF MD

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
1	208000000X	Pediatrics Physician	31257	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	40065	OTHER	IA	WELLMARK INC BCBS
2	G009	OTHER	IA	TRIWEST
3	37876	OTHER	IA	HEALTH SOLUTIONS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	42063106052	OTHER	IA	JOHN DEERE HEALTH

General Provider Information

NPI Number	:	1396738902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY L GRAEFF MD

Provider Business Mailing Address
First Line	:	509 N MADISON ST
Second Line	:
City	:	BLOOMFIELD
State	:	IA
Zip	:	52537-1271
Country	:	US
Telephone Number	:	641-664-3832
Fax Number	:	641-664-1857

Provider Business Practice Location Address
First Line	:	509 N MADISON ST
Second Line	:
City	:	BLOOMFIELD
State	:	IA
Zip	:	52537-1271
Country	:	US
Telephone Number	:	641-664-3832
Fax Number	:	641-664-1857

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	02/10/2021

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Directions to “ MARY L GRAEFF MD” Practice Location

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