Provider Demographics
NPI:1942542584
Name:GRAF, EMILY JACQUELYN (DO)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:JACQUELYN
Last Name:GRAF
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:JACQUELYN
Other - Last Name:LANGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2001 WEST 86TH STREET
Mailing Address - Street 2:DEPARTMENT OF MEDICAL EDUCATION
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260
Mailing Address - Country:US
Mailing Address - Phone:317-338-2281
Mailing Address - Fax:
Practice Address - Street 1:1650 S 41ST ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-7316
Practice Address - Country:US
Practice Address - Phone:920-320-5251
Practice Address - Fax:920-682-2006
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI63544208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation