Provider Demographics
NPI:1457744005
Name:FAIN, GRAHAM P (DO)
Entity Type:Individual
Prefix:DR
First Name:GRAHAM
Middle Name:P
Last Name:FAIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 EAST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:MN
Mailing Address - Zip Code:56441
Mailing Address - Country:US
Mailing Address - Phone:218-546-7000
Mailing Address - Fax:218-546-4400
Practice Address - Street 1:CUYUNA REGIONAL MEDICAL CENTER
Practice Address - Street 2:320 EAST MAIN ST
Practice Address - City:CROSBY
Practice Address - State:MN
Practice Address - Zip Code:56441
Practice Address - Country:US
Practice Address - Phone:218-546-7000
Practice Address - Fax:218-546-7000
Is Sole Proprietor?:No
Enumeration Date:2015-03-06
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102205239207R00000X
MN71129207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine