Healthcare Provider Details

I. General information

NPI: 1003908070
Provider Name (Legal Business Name): MICHAEL FREDERICK GRAF PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MIKE GRAF ATC

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 10/12/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5810 PROVIDENCE DR
HOFFMAN ESTATES IL
60192-4607
US

IV. Provider business mailing address

9977 WOODS DR RM B-70
SKOKIE IL
60077-1057
US

V. Phone/Fax

Practice location:
  • Phone: 847-488-0941
  • Fax:
Mailing address:
  • Phone: 847-663-2664
  • Fax: 847-663-2660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.006317
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096.004604
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: