Provider Demographics
NPI:1043812308
Name:GRAHAM, WILLIAM ANDREW (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ANDREW
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 GETTYSBURG RD UNIT 208
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-6715
Mailing Address - Country:US
Mailing Address - Phone:734-323-5057
Mailing Address - Fax:
Practice Address - Street 1:41424 ANN ARBOR RD E
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-8005
Practice Address - Country:US
Practice Address - Phone:734-254-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI56010258363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant