Provider Demographics
NPI:1225015498
Name:GRAHAM, JAMES C (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:C
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W TEMPLE SUITE 202
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-2187
Mailing Address - Country:US
Mailing Address - Phone:217-342-2040
Mailing Address - Fax:217-342-5816
Practice Address - Street 1:900 W TEMPLE SUITE 202
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2187
Practice Address - Country:US
Practice Address - Phone:217-342-2040
Practice Address - Fax:217-342-5816
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT39139Medicare UPIN
IL1225015498Medicare NSC
789101Medicare ID - Type Unspecified