Provider Demographics
NPI:1528201977
Name:GRAZIANO, MARTHA MAKRA (CAC, DIPLOM, MAC)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:MAKRA
Last Name:GRAZIANO
Suffix:
Gender:F
Credentials:CAC, DIPLOM, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4402 EAGLES COVE CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-4800
Mailing Address - Country:US
Mailing Address - Phone:502-489-1068
Mailing Address - Fax:
Practice Address - Street 1:1999 BROWNSBORO RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2170
Practice Address - Country:US
Practice Address - Phone:502-489-1068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAC037171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist