Provider Demographics
NPI:1396738902
Name:GRAEFF, MARY L (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:GRAEFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:L
Other - Last Name:DAMMEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:509 N MADISON ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52537-1271
Mailing Address - Country:US
Mailing Address - Phone:641-664-3832
Mailing Address - Fax:641-664-1857
Practice Address - Street 1:509 N MADISON ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:IA
Practice Address - Zip Code:52537-1271
Practice Address - Country:US
Practice Address - Phone:641-664-3832
Practice Address - Fax:641-664-1857
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA31257208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA40065OtherWELLMARK INC BCBS
IAG009OtherTRIWEST
IA37876OtherHEALTH SOLUTIONS
IA0155812Medicaid
IA42063106052OtherJOHN DEERE HEALTH
IA42063106052OtherJOHN DEERE HEALTH
IA40065OtherWELLMARK INC BCBS