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NPI Code Detail

MEDICARE: MICKEY GRAPHIA M.D.

MEDICARE: MICKEY GRAPHIA M.D.
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
12086S0129XVascular Surgery Physician125.072356IL
2390200000XStudent in an Organized Health Care Education/Training Program
32086S0129XVascular Surgery Physician338178LA

General Provider Information

NPI Number : 1588105811
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICKEY GRAPHIA M.D.
Provider Business Mailing Address
First Line : 8888 SUMMA AVE
Second Line :
City : BATON ROUGE
State : LA
Zip : 70809-3772
Country : US
Telephone Number : 225-769-4493
Fax Number :
Provider Business Practice Location Address
First Line : 8888 SUMMA AVE
Second Line :
City : BATON ROUGE
State : LA
Zip : 70809-3772
Country : US
Telephone Number : 225-769-4493
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2017
Last Update Date : 12/06/2023

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