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General NPI Number Information
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NPI Number | 1023220720
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Entity Type | Organization
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Legal Business Name | DRS GRAHAM & GRAHAM LTD
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 102 W KENWOOD AVE SUITE 150
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City | DECATUR
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State | IL
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Zip | 62526-4368
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Country | US
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Telephone | 217-875-3668
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Fax | 217-845-4277
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Provider Business Mailing Address
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Address Line | 102 W KENWOOD AVE SUITE 150
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City | DECATUR
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State | IL
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Zip | 62526-4368
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Country | US
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Telephone | 217-875-3668
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Fax | 217-845-4277
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TERRENCE M GRAHAM
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Credential | DPM, FACFAS
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Telephone | 271-875-3668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 016-003032
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License Number State | IL
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