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NPI Code Detail

MEDICARE: DR. CHARLES EVERETT GRADO M.D.

MEDICARE: DR. CHARLES EVERETT GRADO 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
12086S0122XPlastic and Reconstructive Surgery Physician24782IA

Other Identifiers

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

General Provider Information

NPI Number : 1710988217
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES EVERETT GRADO M.D.
Provider Business Mailing Address
First Line : 3705 RIVER RIDGE DR NE
Second Line :
City : CEDAR RAPIDS
State : IA
Zip : 52402-7596
Country : US
Telephone Number : 319-393-1902
Fax Number : 319-393-1867
Provider Business Practice Location Address
First Line : 3705 RIVER RIDGE DR NE
Second Line :
City : CEDAR RAPIDS
State : IA
Zip : 52402-7596
Country : US
Telephone Number : 319-393-1902
Fax Number : 319-393-1867
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2005
Last Update Date : 12/01/2015

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