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General NPI Number Information
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NPI Number | 1336328780
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Entity Type | Organization
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Legal Business Name | BERTRAM ANTHONY GRAVES, MD, PC
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Dates
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Enumeration Date | 11/01/2007
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Last Update Date | 11/28/2012
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Provider Practice Location Address
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Address Line | 3737 N MERIDIAN ST SUITE 104
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City | INDIANAPOLIS
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State | IN
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Zip | 46208-4348
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Country | US
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Telephone | 317-584-4000
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Fax | 317-584-4008
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Provider Business Mailing Address
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Address Line | 3737 N MERIDIAN ST SUITE 104
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City | INDIANAPOLIS
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State | IN
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Zip | 46208-4348
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Country | US
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Telephone | 317-584-4000
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Fax | 317-584-4008
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BERTRAM ANTHONY GRAVES
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Credential | M.D.
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Telephone | 317-584-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 01039628
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License Number State | IN
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