Healthcare Provider Details

I. General information

NPI: 1083776868
Provider Name (Legal Business Name): MICHAEL E GRAHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 04/25/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4430 VETERANS MEMORIAL BLVD
METAIRIE LA
70006-5329
US

IV. Provider business mailing address

1514 JEFFERSON HWY
NEW ORLEANS LA
70121-2429
US

V. Phone/Fax

Practice location:
  • Phone: 504-842-4155
  • Fax: 504-457-0296
Mailing address:
  • Phone: 504-842-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number018221
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: