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NPI Code Detail

MEDICARE: DR. KRISTINE KATHLEEN GRAHAM DO

MEDICARE: DR. KRISTINE KATHLEEN GRAHAM DO
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
1390200000XStudent in an Organized Health Care Education/Training Program
2207Q00000XFamily Medicine Physician5101029315MI
3207P00000XEmergency Medicine Physician5151016337MI

General Provider Information

NPI Number : 1063100626
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KRISTINE KATHLEEN GRAHAM DO
Provider Business Mailing Address
First Line : 1900 COLUMBUS AVE
Second Line :
City : BAY CITY
State : MI
Zip : 48708-6831
Country : US
Telephone Number : 989-894-3000
Fax Number :
Provider Business Practice Location Address
First Line : 1900 COLUMBUS AVE
Second Line :
City : BAY CITY
State : MI
Zip : 48708-6831
Country : US
Telephone Number : 989-894-3000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2023
Last Update Date : 05/28/2026

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