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NPI Code Detail

MEDICARE: MICHAEL HOWARD GRAVATT II MD

MEDICARE: MICHAEL HOWARD GRAVATT II MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianEC071017ME
2207Q00000XFamily Medicine PhysicianMD60147456WA

General Provider Information

NPI Number : 1053517961
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL HOWARD GRAVATT II MD
Provider Business Mailing Address
First Line : PO BOX 190
Second Line :
City : TOPPENISH
State : WA
Zip : 98948-0190
Country : US
Telephone Number : 509-865-2395
Fax Number :
Provider Business Practice Location Address
First Line : 620 W 1ST ST
Second Line :
City : WAPATO
State : WA
Zip : 98951-1108
Country : US
Telephone Number : 509-877-4111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2007
Last Update Date : 04/22/2024

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