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NPI Code Detail

MEDICARE: EMILY ANNE GRAHAM

MEDICARE: EMILY ANNE GRAHAM
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
1363A00000XPhysician Assistant5601013006MI

General Provider Information

NPI Number : 1699545251
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY ANNE GRAHAM
Provider Business Mailing Address
First Line : 1030 HARRINGTON ST STE 101
Second Line :
City : MOUNT CLEMENS
State : MI
Zip : 48043-2967
Country : US
Telephone Number : 586-464-4010
Fax Number :
Provider Business Practice Location Address
First Line : 26300 WOODWARD AVE
Second Line :
City : ROYAL OAK
State : MI
Zip : 48067-0917
Country : US
Telephone Number : 248-336-4000
Fax Number : 248-336-9137
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2024
Last Update Date : 06/03/2026

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