Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 69436 | WI |
N | 208200000X | Surgeon | 69436 | WI |
N | 208600000X | Surgeon | 69436 | WI |
NPI | 1760777056 |
---|---|
Provider Name | Dr. Adam Stephen Alexander Gracon |
First Address | Indianapolis, IN 46254-9716 |
Second Address | Indianapolis, IN 46254-9716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2011 |
Last Update Date | 27/07/2020 |