Provider Demographics
NPI:1356346167
Name:GRAHAM, JAMES MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6635
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:4130 DUTCHMANS LN
Practice Address - Street 2:STE 400
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4711
Practice Address - Country:US
Practice Address - Phone:502-897-0697
Practice Address - Fax:502-897-0658
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY22664207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0700049OtherUNITED HEALTHCARE
KY50036612OtherPASSPORT - WS
KY160032459OtherRAILROAD
KY610673930AOtherHUMANA
KY1519000000044478OtherBLUE CROSS/BLUE SHIELD
KY64226640Medicaid
KY0700049OtherUNITED HEALTHCARE
KY1519000000044478OtherBLUE CROSS/BLUE SHIELD
KYK031620Medicare PIN