Provider Demographics
NPI:1497749477
Name:GRAVES, ALECIA ELLEN (MD)
Entity Type:Individual
Prefix:
First Name:ALECIA
Middle Name:ELLEN
Last Name:GRAVES
Suffix:
Gender:F
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:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:4123 DUTCHMANS LANE
Practice Address - Street 2:SUITE 507
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4730
Practice Address - Country:US
Practice Address - Phone:502-423-9595
Practice Address - Fax:502-719-0161
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31847207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000057120POtherHUMANA - WS
KY5002880OtherMEDICAID PASSPORT
KY65925109OtherMEDICAID GRP
KY8382591OtherCIGNA-WS
KY000000724240OtherANTHEM - WS
KY1166219OtherGROUP MEDICAID PASSPORT
KY50034482OtherPASSPORT - WS
KY1052052OtherPASSPORT
KY127014OtherSIHO - WS
KY5581OtherMEDICARE GRP
KY64318470Medicaid
KY64318470Medicaid
KY000000724240OtherANTHEM - WS
KY65925109OtherMEDICAID GRP