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General NPI Number Information
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NPI Number | 1720244163
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Entity Type | Individual
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Provider Name | JUSTIN DONALD GRAHAM M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/05/2008
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Last Update Date | 09/25/2020
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Provider Practice Location Address
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Address Line | 6363 FRANCE AVE S STE 200
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City | EDINA
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State | MN
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Zip | 55435-2140
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Country | US
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Telephone | 952-230-9100
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Fax | 952-922-2525
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Provider Business Mailing Address
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Address Line | 6363 FRANCE AVE S STE 200
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City | EDINA
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State | MN
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Zip | 55435-2140
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Country | US
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Telephone | 952-230-9100
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Fax | 952-922-2525
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 52451
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License Number State | MN
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