1942542584 NPI number — MRS. EMILY JACQUELYN GRAF D.O.

Table of content: MRS. EMILY JACQUELYN GRAF D.O. (NPI 1942542584)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942542584 NPI number — MRS. EMILY JACQUELYN GRAF D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAF
Provider First Name:
EMILY
Provider Middle Name:
JACQUELYN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LANGE
Provider Other First Name:
EMILY
Provider Other Middle Name:
JACQUELYN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942542584
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 WEST 86TH STREET
Provider Second Line Business Mailing Address:
DEPARTMENT OF MEDICAL EDUCATION
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-338-2281
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1650 S 41ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANITOWOC
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54220-7316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-320-5251
Provider Business Practice Location Address Fax Number:
920-682-2006
Provider Enumeration Date:
03/21/2013

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: 208100000X , with the licence number:  63544 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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