MEDICARE: GRAHAM SPENCER REID 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	213E00000X	Podiatrist	MED-POD-LIC-174352	MT
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1366188468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRAHAM SPENCER REID DPM

Provider Business Mailing Address
First Line	:	530 LONG CV
Second Line	:
City	:	AVON LAKE
State	:	OH
Zip	:	44012-3333
Country	:	US
Telephone Number	:	406-580-9586
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 N LAKE DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-4508
Country	:	US
Telephone Number	:	414-585-1000
Fax Number	:

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

Provider Enumeration Date	:	05/11/2022
Last Update Date	:	06/12/2026

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