Healthcare Provider Details

I. General information

NPI: 1720901572
Provider Name (Legal Business Name): GRAHAM GALLOWAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2353 BADGER ST
MARQUETTE MI
49855-2303
US

IV. Provider business mailing address

2353 BADGER ST
MARQUETTE MI
49855-2303
US

V. Phone/Fax

Practice location:
  • Phone: 906-273-1121
  • Fax: 906-225-6706
Mailing address:
  • Phone: 906-273-1121
  • Fax: 906-225-6706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: