Healthcare Provider Details

I. General information

NPI: 1144203514
Provider Name (Legal Business Name): KATHERINE ELIZABETH MCGRAW M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 04/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S BURR ST STE B
MITCHELL SD
57301-4585
US

IV. Provider business mailing address

PO BOX 459
MITCHELL SD
57301-0459
US

V. Phone/Fax

Practice location:
  • Phone: 605-292-0695
  • Fax: 605-292-0699
Mailing address:
  • Phone: 605-630-0407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL9352
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number7119
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: