Provider Demographics
NPI:1417956756
Name:GRABER, STARLA D (MD)
Entity Type:Individual
Prefix:DR
First Name:STARLA
Middle Name:D
Last Name:GRABER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3245 HEALTH DR
Mailing Address - Street 2:STE 100
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-1380
Mailing Address - Country:US
Mailing Address - Phone:574-647-2129
Mailing Address - Fax:574-522-0039
Practice Address - Street 1:2405 WEST LEXINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-1417
Practice Address - Country:US
Practice Address - Phone:574-524-7575
Practice Address - Fax:574-524-7576
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047381207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200153620Medicaid
IN15431OtherPHYSICIANS HEALTH PLAN
IN000000082177OtherANTHEM BLUE CROSS
IN000000082177OtherANTHEM BLUE CROSS
IN200153620Medicaid
IN1056320001Medicare NSC