Provider Demographics
NPI:1710988217
Name:GRADO, CHARLES EVERETT (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EVERETT
Last Name:GRADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 RIVER RIDGE DR NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-7596
Mailing Address - Country:US
Mailing Address - Phone:319-393-1902
Mailing Address - Fax:319-393-1867
Practice Address - Street 1:3705 RIVER RIDGE DR NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-7596
Practice Address - Country:US
Practice Address - Phone:319-393-1902
Practice Address - Fax:319-393-1867
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA247822086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0229138Medicaid
IA0229138Medicaid
IAI21887Medicare PIN
IAI21887Medicare PIN