Healthcare Provider Details

I. General information

NPI: 1427097682
Provider Name (Legal Business Name): MARY EVELYN GRABER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 02/14/2026
Certification Date: 02/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 E DOUGLAS SUITE 309
MISHAWAKA IN
46545-1467
US

IV. Provider business mailing address

PO BOX 719094
CHICAGO IL
60677-9318
US

V. Phone/Fax

Practice location:
  • Phone: 574-252-2640
  • Fax: 574-252-2650
Mailing address:
  • Phone: 317-777-6435
  • Fax: 317-777-6644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01031977
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number01031977
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: