MEDICARE: KIRSTEN GRAU 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	390200000X	Student in an Organized Health Care Education/Training Program
2	213ES0103X	Foot & Ankle Surgery Podiatrist	N006714	NY
3	213ES0103X	Foot & Ankle Surgery Podiatrist	PO60300312	WA

General Provider Information

NPI Number	:	1538398706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRSTEN GRAU DPM

Provider Business Mailing Address
First Line	:	27 W SAND LAKE RD
Second Line	:
City	:	WYNANTSKILL
State	:	NY
Zip	:	12198-7958
Country	:	US
Telephone Number	:	815-382-5940
Fax Number	:

Provider Business Practice Location Address
First Line	:	27 W SAND LAKE RD
Second Line	:
City	:	WYNANTSKILL
State	:	NY
Zip	:	12198-7958
Country	:	US
Telephone Number	:	518-283-9457
Fax Number	:

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

Provider Enumeration Date	:	07/09/2009
Last Update Date	:	05/08/2019

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