Provider Demographics
NPI:1023169026
Name:GRAVES, SCOTT ANDREW (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ANDREW
Last Name:GRAVES
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 1:3495 S CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48519-1455
Mailing Address - Country:US
Mailing Address - Phone:810-424-2007
Mailing Address - Fax:810-743-1099
Practice Address - Street 1:2337 W MOUNT MORRIS RD
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:MI
Practice Address - Zip Code:48458-8256
Practice Address - Country:US
Practice Address - Phone:810-564-9524
Practice Address - Fax:810-564-9553
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045165207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0802508861OtherBCBSM
MI4141025Medicaid
MIA78632Medicare UPIN
MI4141025Medicaid