Provider Demographics
NPI:1023107851
Name:GRAEHL, PHILLIP MADSEN (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:MADSEN
Last Name:GRAEHL
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 1:4780 N JOSEY LN
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4615
Mailing Address - Country:US
Mailing Address - Phone:972-492-1334
Mailing Address - Fax:972-492-5174
Practice Address - Street 1:4780 N JOSEY LN
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4615
Practice Address - Country:US
Practice Address - Phone:972-492-1334
Practice Address - Fax:972-492-5174
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9967207XS0114X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6484850003OtherMEDICARE NSC - EFFECT. 02/01/2011
TX8CR155OtherBCBS TX 02/01/11
TXTXB117513OtherMEDICARE PART B - EFFECT 02/01/2011
TX122271305Medicaid
TXP00913367OtherMEDICARE RAILROAD - EFFECT. 02/01/2011
TX8F4981OtherBLUE CROSS BLUE SHIELD
TXP00913367OtherMEDICARE RAILROAD - EFFECT. 02/01/2011
TXTXB117513OtherMEDICARE PART B - EFFECT 02/01/2011
TX8F4981OtherBLUE CROSS BLUE SHIELD
TX122271305Medicaid