Healthcare Provider Details

I. General information

NPI: 1740627256
Provider Name (Legal Business Name): SARAH GRABOIS TARAI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2013
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 N LEBANON ST SUITE 310
LEBANON IN
46052-8621
US

IV. Provider business mailing address

2705 N LEBANON ST SUITE 305
LEBANON IN
46052-8621
US

V. Phone/Fax

Practice location:
  • Phone: 765-485-8900
  • Fax: 765-485-8909
Mailing address:
  • Phone: 765-485-8900
  • Fax: 765-485-8909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01076711A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: