Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 56891 | MN |
N | 111NI0900X | Internist | 56891 | MN |
Y | 207RA0401X | Internist - Addiction Medicine | 56891 | MN |
NPI | 1770809873 |
---|---|
Provider Name | Dr. Brian John Grahan |
First Address | Minneapolis, MN 55415-1623 |
Second Address | Minneapolis, MN 55415-1623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2010 |
Last Update Date | 06/03/2020 |