MEDICARE: DR. MICHAEL WILLIAM GRAFE 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
1	174400000X	Specialist	A69430	CA

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	:	1922194711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL WILLIAM GRAFE M.D.

Provider Business Mailing Address
First Line	:	208 CONCOURSE BLVD
Second Line	:	#1
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-8210
Country	:	US
Telephone Number	:	707-544-3400
Fax Number	:	707-544-0137

Provider Business Practice Location Address
First Line	:	208 CONCOURSE BLVD
Second Line	:	#1
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-8210
Country	:	US
Telephone Number	:	707-544-3400
Fax Number	:	707-544-0137

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	06/30/2020

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