Healthcare Provider Details

I. General information

NPI: 1831024322
Provider Name (Legal Business Name): IAN A GRAGER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 OAKWOOD ST
YPSILANTI MI
48197-6229
US

IV. Provider business mailing address

3611 PRESCOTT DR
HOWELL MI
48843-6980
US

V. Phone/Fax

Practice location:
  • Phone: 734-487-1849
  • Fax:
Mailing address:
  • Phone: 810-588-2117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: