Healthcare Provider Details

I. General information

NPI: 1801895552
Provider Name (Legal Business Name): ALVIN R GRABER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 N NAPPANEE ST
NAPPANEE IN
46550-1625
US

IV. Provider business mailing address

357 N NAPPANEE ST
NAPPANEE IN
46550-1625
US

V. Phone/Fax

Practice location:
  • Phone: 574-773-3141
  • Fax: 574-773-3143
Mailing address:
  • Phone: 574-773-3141
  • Fax: 574-773-3143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01020112A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: