Provider Demographics
NPI:1356160659
Name:GRAVES GILBERT CLINIC PLLC
Entity type:Organization
Organization Name:GRAVES GILBERT CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:D'ERAMO
Authorized Official - Suffix:
Authorized Official - Credentials:DHA
Authorized Official - Phone:270-780-0549
Mailing Address - Street 1:201 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1708
Mailing Address - Country:US
Mailing Address - Phone:270-781-5111
Mailing Address - Fax:
Practice Address - Street 1:1225 FAIRWAY ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-2477
Practice Address - Country:US
Practice Address - Phone:270-781-5111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRAVES GILBERT CLINIC PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-04
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site