Provider Demographics
NPI:1659898781
Name:GRAHAM, KALEI SHAE
Entity Type:Individual
Prefix:
First Name:KALEI
Middle Name:SHAE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 OLD ROADWAY
Mailing Address - Street 2:
Mailing Address - City:CROPWELL
Mailing Address - State:AL
Mailing Address - Zip Code:35054-3756
Mailing Address - Country:US
Mailing Address - Phone:205-362-0581
Mailing Address - Fax:
Practice Address - Street 1:800 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-6715
Practice Address - Country:US
Practice Address - Phone:205-726-2011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALBEG836663342OtherBLUE CROSS BLUE SHIELD OF ALABAMA