Provider Demographics
NPI:1558461459
Name:GRAEBER, MICHAEL COLEMAN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:COLEMAN
Last Name:GRAEBER
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 1:971 LAKELAND DR
Mailing Address - Street 2:SUITE 560
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4607
Mailing Address - Country:US
Mailing Address - Phone:601-982-9826
Mailing Address - Fax:601-982-9535
Practice Address - Street 1:971 LAKELAND DR
Practice Address - Street 2:SUITE 560 MUSCLE AND NERVE PA
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4607
Practice Address - Country:US
Practice Address - Phone:601-982-9826
Practice Address - Fax:601-982-9535
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS107702084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0530055OtherUNITED HEALTH CARE
MS0018496Medicaid
MS09014965Medicaid
C47938Medicare UPIN
MS0018496Medicaid