Healthcare Provider Details

I. General information

NPI: 1164496923
Provider Name (Legal Business Name): MICHAEL GRAHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8352 W WARM SPRINGS RD STE 200
LAS VEGAS NV
89113-3629
US

IV. Provider business mailing address

8352 W WARM SPRINGS RD STE 200
LAS VEGAS NV
89113-3629
US

V. Phone/Fax

Practice location:
  • Phone: 702-330-0555
  • Fax: 702-832-1128
Mailing address:
  • Phone: 702-330-0555
  • Fax: 702-832-1128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number23389
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: