MEDICARE: DR. JAMES C GRAHAM DPM

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	213EP1101X	Primary Podiatric Medicine Podiatrist		IL
2	213ES0103X	Foot & Ankle Surgery Podiatrist		IL

General Provider Information

NPI Number	:	1225015498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES C GRAHAM DPM

Provider Business Mailing Address
First Line	:	900 W TEMPLE SUITE 202
Second Line	:
City	:	EFFINGHAM
State	:	IL
Zip	:	62401-2187
Country	:	US
Telephone Number	:	217-342-2040
Fax Number	:	217-342-5816

Provider Business Practice Location Address
First Line	:	900 W TEMPLE SUITE 202
Second Line	:
City	:	EFFINGHAM
State	:	IL
Zip	:	62401-2187
Country	:	US
Telephone Number	:	217-342-2040
Fax Number	:	217-342-5816

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

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	10/30/2007

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