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NPI Code Detail

MEDICARE: GARY LEE GRAHAM NP

MEDICARE: GARY LEE GRAHAM NP
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner4704197715MI

General Provider Information

NPI Number : 1992129704
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARY LEE GRAHAM NP
Provider Business Mailing Address
First Line : 34290 FORD RD
Second Line :
City : WESTLAND
State : MI
Zip : 48185-3051
Country : US
Telephone Number : 734-324-8326
Fax Number :
Provider Business Practice Location Address
First Line : 34290 FORD RD
Second Line :
City : WESTLAND
State : MI
Zip : 48185-3051
Country : US
Telephone Number : 734-324-8326
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2014
Last Update Date : 01/09/2024

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