MEDICARE: ELISE ALVES GRABER MD

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	208000000X	Pediatrics Physician	2018-00300	NC
2	2080P0204X	Pediatric Emergency Medicine (Pediatrics) Physician	149461	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629462015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISE ALVES GRABER MD

Provider Business Mailing Address
First Line	:	2801 NW 79TH AVE
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33122-1174
Country	:	US
Telephone Number	:	786-466-1040
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 NW 79TH AVE
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33122-1174
Country	:	US
Telephone Number	:	786-466-1040
Fax Number	:

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

Provider Enumeration Date	:	03/24/2015
Last Update Date	:	08/24/2021

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