Provider Demographics
NPI:1376538900
Name:GRAHAM, BRETT A (MD)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:A
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1100 SOUTHFIELD DR
Mailing Address - Street 2:SUITE 1370
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-4498
Mailing Address - Country:US
Mailing Address - Phone:317-837-5571
Mailing Address - Fax:317-837-5580
Practice Address - Street 1:1411 S GREEN ST
Practice Address - Street 2:SUITE 130
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-2049
Practice Address - Country:US
Practice Address - Phone:317-858-4610
Practice Address - Fax:317-858-4620
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2021-03-05
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Provider Licenses
StateLicense IDTaxonomies
IN01040479A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100334680BMedicaid
354590AAMedicare PIN
IN100334680BMedicaid