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General NPI Number Information
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NPI Number | 1083608566
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Entity Type | Individual
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Provider Name | MEDHAT N. GRACE M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/09/2005
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Last Update Date | 06/17/2015
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Provider Practice Location Address
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Address Line | 1225 FAIRWAY ST
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City | BOWLING GREEN
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State | KY
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Zip | 42103-2477
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Country | US
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Telephone | 270-781-3910
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Fax | 270-842-7177
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Provider Business Mailing Address
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Address Line | 201 PARK ST
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City | BOWLING GREEN
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State | KY
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Zip | 42101-1759
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Country | US
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Telephone | 270-780-2497
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Fax | 270-783-0454
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 33548
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License Number State | KY
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