MEDICARE: DR. KARLADINE E GRAVES D.O.

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	207Q00000X	Family Medicine Physician	R7430	MO

General Provider Information

NPI Number	:	1215931647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KARLADINE E GRAVES D.O.

Provider Business Mailing Address
First Line	:	6130 N MATTOX RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64151-2500
Country	:	US
Telephone Number	:	816-746-1833
Fax Number	:

Provider Business Practice Location Address
First Line	:	2750 CLAY EDWARDS DR
Second Line	:	STE 612
City	:	NORTH KANSAS CITY
State	:	MO
Zip	:	64116-3258
Country	:	US
Telephone Number	:	816-221-7744
Fax Number	:	816-221-7755

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	02/17/2010

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