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General NPI Number Information
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NPI Number | 1427097682
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Entity Type | Individual
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Provider Name | MARY EVELYN GRABER M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/05/2006
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Last Update Date | 09/14/2016
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Provider Practice Location Address
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Address Line | 611 E DOUGLAS SUITE 309
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City | MISHAWAKA
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State | IN
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Zip | 46545-1467
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Country | US
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Telephone | 574-252-2640
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Fax | 574-252-2650
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Provider Business Mailing Address
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Address Line | 707 E CEDAR ST STE 200
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City | SOUTH BEND
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State | IN
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Zip | 46617-2057
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Country | US
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Telephone | 574-472-6700
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Fax | 574-472-6746
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 01031977
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 01031977
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License Number State | IN
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