Provider Demographics
NPI:1023220720
Name:DRS GRAHAM & GRAHAM LTD
Entity Type:Organization
Organization Name:DRS GRAHAM & GRAHAM LTD
Other - Org Name:DRS GRAHAM & GRAHAM LTD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM, FACFAS
Authorized Official - Phone:271-875-3668
Mailing Address - Street 1:102 W KENWOOD AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-4368
Mailing Address - Country:US
Mailing Address - Phone:217-875-3668
Mailing Address - Fax:217-845-4277
Practice Address - Street 1:102 W KENWOOD AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-4368
Practice Address - Country:US
Practice Address - Phone:217-875-3668
Practice Address - Fax:217-845-4277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-003032213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCC0187OtherRR GROUP
IL=========OtherEIN
IL216426Medicare UPIN