Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 33216 | IA |
N | 111NI0900X | Internist | 33216 | IA |
Y | 207U00000X | Nuclear Medicine Specialist | 33216 | IA |
NPI | 1205824174 |
---|---|
Provider Name | Michael M Graham |
First Address | Iowa City, IA 52242-1009 |
Second Address | Iowa City, IA 52242-1009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2005 |
Last Update Date | 04/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0201368 | (05) | IA |
12042 | WELLMARK BCBS (01) | IA |
A04583 | (02) |