1063417137 NPI number — SHERRI LYNN GRAF DO

Table of content: SHERRI LYNN GRAF DO (NPI 1063417137)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063417137 NPI number — SHERRI LYNN GRAF DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAF
Provider First Name:
SHERRI
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063417137
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 7190
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOOMFIELD HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-223-9202
Provider Business Mailing Address Fax Number:
248-223-9302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29877 TELEGRAPH ROAD
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-223-9202
Provider Business Practice Location Address Fax Number:
248-223-9302
Provider Enumeration Date:
06/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  5101013164 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 450530711 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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