Provider Demographics
NPI:1902045040
Name:GRAIDUKEL MED INC
Entity Type:Organization
Organization Name:GRAIDUKEL MED INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IDUAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY-DOKUBO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-296-0792
Mailing Address - Street 1:PO BOX 50082
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91115-0082
Mailing Address - Country:US
Mailing Address - Phone:626-296-0792
Mailing Address - Fax:
Practice Address - Street 1:2750 E WASHINGTON BLVD
Practice Address - Street 2:SUITE #370
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-1448
Practice Address - Country:US
Practice Address - Phone:626-296-0792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty