Provider Demographics
NPI:1942266036
Name:GRAZETTE, EUDORA BARBARA (MD)
Entity Type:Individual
Prefix:
First Name:EUDORA
Middle Name:BARBARA
Last Name:GRAZETTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 FRANCE AVE S
Mailing Address - Street 2:SUITE 328
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4525
Mailing Address - Country:US
Mailing Address - Phone:952-224-7072
Mailing Address - Fax:952-224-7073
Practice Address - Street 1:7300 FRANCE AVE S
Practice Address - Street 2:SUITE 328
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4525
Practice Address - Country:US
Practice Address - Phone:952-224-7072
Practice Address - Fax:952-224-7073
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN32031207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0705175OtherMEDICA
MNB99801015042OtherPREFERRED ONE
MN121425OtherUCARE MINNESOTA
MN380092000Medicaid
MN501L8GROtherBLUE CROSS /BLUE SHEILD
MNHP10504OtherHEALTHPARTNERS
MN0705175OtherMEDICA
MNB99801015042OtherPREFERRED ONE