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General NPI Number Information
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NPI Number | 1588008536
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Entity Type | Organization
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Legal Business Name | MICHAEL F. GRAHAM, MD LLC
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Dates
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Enumeration Date | 04/22/2013
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Last Update Date | 04/22/2013
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Provider Practice Location Address
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Address Line | 1 SW 129TH AVE 200
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-1761
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Country | US
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Telephone | 954-437-7358
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Fax | 954-437-4197
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Provider Business Mailing Address
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Address Line | 1 SW 129TH AVE 200
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-1761
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Country | US
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Telephone | 954-437-7358
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Fax | 954-437-4197
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MICHAEL FRED GRAHAM
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Credential | MD
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Telephone | 954-437-7358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME33568
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License Number State | FL
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