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NPI Code Detail

MEDICARE: TODD LEE GRACEN M.D.

MEDICARE: TODD LEE GRACEN 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
1207R00000XInternal Medicine PhysicianME 67237FL

General Provider Information

NPI Number : 1639397904
Entity Type Code : Individual
Provider Name (Legal Business Name) : TODD LEE GRACEN M.D.
Provider Business Mailing Address
First Line : 1209 LAKESIDE DR
Second Line :
City : BRANDON
State : FL
Zip : 33510-4109
Country : US
Telephone Number : 813-661-3662
Fax Number :
Provider Business Practice Location Address
First Line : 3022 EASTWAY DR STE 1-3
Second Line :
City : CHARLOTTE
State : NC
Zip : 28205-5642
Country : US
Telephone Number : 704-251-8228
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2007
Last Update Date : 07/17/2024

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Directions to “ TODD LEE GRACEN M.D.” Practice Location

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