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General NPI Number Information
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NPI Number | 1104066315
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Entity Type | Organization
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Legal Business Name | ST. MARYS MEDICAL CENTER, PC
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Dates
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Enumeration Date | 02/27/2009
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Last Update Date | 05/24/2012
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Provider Practice Location Address
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Address Line | 943 E PORTAGE AVE
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City | SAULT SAINTE MARIE
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State | MI
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Zip | 49783-2465
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Country | US
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Telephone | 906-632-7878
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Fax |
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Provider Business Mailing Address
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Address Line | 943 E PORTAGE AVE
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City | SAULT SAINTE MARIE
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State | MI
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Zip | 49783-2465
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Country | US
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Telephone | 906-632-7878
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT JAMES GRAHAM
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Credential | DO
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Telephone | 906-632-7878
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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 | RG005899
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License Number State | MI
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