Provider Demographics
NPI:1003908070
Name:GRAF, MICHAEL FREDERICK (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:FREDERICK
Last Name:GRAF
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:MIKE
Other - Middle Name:
Other - Last Name:GRAF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC
Mailing Address - Street 1:9977 WOODS DR RM B-70
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1057
Mailing Address - Country:US
Mailing Address - Phone:847-663-2664
Mailing Address - Fax:847-663-2660
Practice Address - Street 1:5810 PROVIDENCE DR
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60192-4607
Practice Address - Country:US
Practice Address - Phone:847-488-0941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0046042255A2300X
IL085.006317363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT#22OtherATHLETIC TRAINER