MEDICARE: MATEUSZ J GRACA 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
1	207L00000X	Anesthesiology Physician	ME161251	FL
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	ME161251	FL
3	208VP0000X	Pain Medicine Physician	ME161251	FL
4	208VP0014X	Interventional Pain Medicine Physician	ME161251	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154982502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATEUSZ J GRACA MD

Provider Business Mailing Address
First Line	:	6000 N FEDERAL HWY
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-2226
Country	:	US
Telephone Number	:	954-771-2551
Fax Number	:	954-492-3830

Provider Business Practice Location Address
First Line	:	6000 N FEDERAL HWY
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-2226
Country	:	US
Telephone Number	:	954-771-2551
Fax Number	:	954-492-3830

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2019
Last Update Date	:	11/06/2024

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