Provider Demographics
NPI:1477592657
Name:GRAHAM, NEIL D (MD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:D
Last Name:GRAHAM
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 1:9000 WAUKEGAN RD STE 240
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2128
Mailing Address - Country:US
Mailing Address - Phone:847-296-1177
Mailing Address - Fax:847-296-6437
Practice Address - Street 1:9000 WAUKEGAN RD STE 240
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-2128
Practice Address - Country:US
Practice Address - Phone:847-296-1177
Practice Address - Fax:847-296-6437
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-111988208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics