Provider Demographics
NPI:1265494850
Name:GRATER, SIMEON (MD)
Entity Type:Individual
Prefix:DR
First Name:SIMEON
Middle Name:
Last Name:GRATER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 ALBANY RD
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62903-7605
Mailing Address - Country:US
Mailing Address - Phone:618-549-4688
Mailing Address - Fax:
Practice Address - Street 1:35 ALBANY RD
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62903-7605
Practice Address - Country:US
Practice Address - Phone:618-549-4688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCH4443OtherRR GROUP #
ILK44979Medicare PIN
ILC43391Medicare UPIN
IL624920Medicare ID - Type UnspecifiedMEDICARE NUMBER