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General NPI Number Information
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NPI Number | 1659934933
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Entity Type | Individual
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Provider Name | STEPHANE BERNARD DEGRAFF MD
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Gender | Male
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Dates
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Enumeration Date | 04/22/2019
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Last Update Date | 08/09/2024
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Provider Practice Location Address
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Address Line | 4320 FIR ST STE 4141
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City | EAST CHICAGO
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State | IN
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Zip | 46312-3052
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Country | US
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Telephone | 219-392-7466
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Fax | 219-392-7470
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Provider Business Mailing Address
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Address Line | 8558 BROADWAY
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City | MERRILLVILLE
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State | IN
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Zip | 46410-7032
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Country | US
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Telephone | 219-392-7084
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Fax | 219-703-6854
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME158905
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 01094316A
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License Number State | IN
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