Provider Demographics
NPI:1659612711
Name:GRAHAM, STEPHEN E (DVM)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:E
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17622 BURLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:UNION GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53182-9413
Mailing Address - Country:US
Mailing Address - Phone:262-859-2560
Mailing Address - Fax:262-859-0459
Practice Address - Street 1:17622 BURLINGTON RD
Practice Address - Street 2:
Practice Address - City:UNION GROVE
Practice Address - State:WI
Practice Address - Zip Code:53182-9413
Practice Address - Country:US
Practice Address - Phone:262-859-2560
Practice Address - Fax:262-859-0459
Is Sole Proprietor?:No
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL090009537174M00000X
WI6120-50174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian