Healthcare Provider Details

I. General information

NPI: 1326027608
Provider Name (Legal Business Name): CARA ELAINE GRAHAM AU.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 09/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 WAUKEGAN RD SUITE 200
DEERFIELD IL
60015-4342
US

IV. Provider business mailing address

415 CHESTER DR
RICHMOND IN
47374-1001
US

V. Phone/Fax

Practice location:
  • Phone: 800-317-0711
  • Fax: 800-434-7113
Mailing address:
  • Phone: 765-962-2242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number23002322A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: