Provider Demographics
NPI:1073782751
Name:GRACIE, KEVIN WILLIAM (CST/CFA)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:WILLIAM
Last Name:GRACIE
Suffix:
Gender:M
Credentials:CST/CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 MONROE PL
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-8360
Mailing Address - Country:US
Mailing Address - Phone:612-802-8584
Mailing Address - Fax:952-935-4750
Practice Address - Street 1:403 MONROE PL
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-8360
Practice Address - Country:US
Practice Address - Phone:612-802-8584
Practice Address - Fax:952-935-4750
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist