Provider Demographics
NPI:1013334663
Name:GRAEFF, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:GRAEFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W TRAVELERS TRL
Mailing Address - Street 2:SUITE 11
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-2550
Mailing Address - Country:US
Mailing Address - Phone:952-767-3356
Mailing Address - Fax:952-767-3356
Practice Address - Street 1:201 W TRAVELERS TRL
Practice Address - Street 2:SUITE 11
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-2550
Practice Address - Country:US
Practice Address - Phone:952-767-3356
Practice Address - Fax:952-767-3356
Is Sole Proprietor?:No
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver