=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801014238
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHARINE ROXANNE GRAWE M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2007
-----------------------------------------------------
Last Update Date | 01/15/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10330 SAWMILL PKWY SUITE 450
-----------------------------------------------------
City | POWELL
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43065-7790
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-764-7699
-----------------------------------------------------
Fax | 614-764-2664
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3982 POWELL RD. SUITE 127
-----------------------------------------------------
City | POWELL
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-764-7699
-----------------------------------------------------
Fax | 614-764-2664
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0122X
-----------------------------------------------------
Taxonomy Name | Plastic and Reconstructive Surgery Physician
-----------------------------------------------------
License Number | 57-010817
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------