Provider Demographics
NPI:1780637314
Name:GRAHAM, DAVID E (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:GRAHAM
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 1:20375 WEST 151ST
Mailing Address - Street 2:SUITE #105
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061
Mailing Address - Country:US
Mailing Address - Phone:913-782-8487
Mailing Address - Fax:913-782-4634
Practice Address - Street 1:20375 WEST 151ST
Practice Address - Street 2:SUITE #105
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061
Practice Address - Country:US
Practice Address - Phone:913-782-8487
Practice Address - Fax:913-782-4634
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS0416123207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100144110DMedicaid
KS100144110DMedicaid
KS0334549DMedicare PIN