Provider Demographics
NPI:1033200720
Name:GRAUR, OCTAVIA B (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:OCTAVIA
Middle Name:B
Last Name:GRAUR
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-4018
Mailing Address - Country:US
Mailing Address - Phone:231-728-5758
Mailing Address - Fax:231-728-5636
Practice Address - Street 1:3104 HENRY ST
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-4018
Practice Address - Country:US
Practice Address - Phone:231-728-5758
Practice Address - Fax:231-728-5636
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301081261207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2099460Medicaid
MI4506402Medicaid
H85258Medicare UPIN
MI0F11505Medicare PIN
MI0F16024Medicare PIN