Provider Demographics
NPI:1669579819
Name:GRACHECK, JAMES E (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
Last Name:GRACHECK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:11133 LOCUST ST # A
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-3622
Mailing Address - Country:US
Mailing Address - Phone:816-942-8902
Mailing Address - Fax:816-942-8926
Practice Address - Street 1:11133 LOCUST ST # A
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-3622
Practice Address - Country:US
Practice Address - Phone:816-942-8902
Practice Address - Fax:816-942-8926
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO33627207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO240879205Medicaid
MO240879205Medicaid