Provider Demographics
NPI:1457323149
Name:GRAHAM, NOEL M (MD)
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:M
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NOEL
Other - Middle Name:MICHAEL
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:241 NW MCNARY CT
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-4011
Mailing Address - Country:US
Mailing Address - Phone:816-347-0064
Mailing Address - Fax:816-347-0593
Practice Address - Street 1:241 NW MCNARY CT
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-4011
Practice Address - Country:US
Practice Address - Phone:816-347-0064
Practice Address - Fax:816-347-0593
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001011231208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H61832Medicare UPIN