Healthcare Provider Details

I. General information

NPI: 1912050287
Provider Name (Legal Business Name): MICHAEL J GRAFE DO LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 01/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S ROSELAWN AVE
ARTESIA NM
88210-2462
US

IV. Provider business mailing address

301 S ROSELAWN AVE
ARTESIA NM
88210-2462
US

V. Phone/Fax

Practice location:
  • Phone: 575-746-3615
  • Fax: 575-748-2544
Mailing address:
  • Phone: 575-746-3615
  • Fax: 575-748-2544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA-718-81
License Number StateNM

VIII. Authorized Official

Name: DR. MICHAEL J. GRAFE
Title or Position: SOLE OWNER
Credential: DO
Phone: 575-746-3616