Provider Demographics
NPI:1679533509
Name:GRAHOVAC, JURE
Entity Type:Individual
Prefix:
First Name:JURE
Middle Name:
Last Name:GRAHOVAC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4760 W WICKFORD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48302-2381
Mailing Address - Country:US
Mailing Address - Phone:248-644-7234
Mailing Address - Fax:
Practice Address - Street 1:5050 SCHAEFER RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3249
Practice Address - Country:US
Practice Address - Phone:313-581-2600
Practice Address - Fax:313-581-0228
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJG035488207V00000X
MI4301035488207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI106465OtherGREAT LAKES HEALTH PLAN
MI160H261380OtherBCBSM/BCN
MI001010OtherMIDWEST HEALTH PLAN
MI24979OtherOMNICARE HEALTH PLAN
MI118668OtherCARE CHOICES
MI4564155OtherAETNA
MIP00122436OtherPALMETTO