Provider Demographics
NPI:1649336439
Name:GRAF-DIXON, KEVIN MICHELLE (LM)
Entity type:Individual
Prefix:MS
First Name:KEVIN
Middle Name:MICHELLE
Last Name:GRAF-DIXON
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:KEVIN
Other - Middle Name:MICHELLE
Other - Last Name:GRAF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1110 LEXINGTON GREEN LN
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1022
Mailing Address - Country:US
Mailing Address - Phone:407-322-9944
Mailing Address - Fax:407-322-9947
Practice Address - Street 1:1110 LEXINGTON GREEN LN
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1022
Practice Address - Country:US
Practice Address - Phone:407-322-9944
Practice Address - Fax:407-322-9947
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW83176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY7159OtherBLUE CROSS AND BLUE SHIEL
FL340603200Medicaid