Provider Demographics
NPI:1720244163
Name:GRAHAM, JUSTIN DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:DONALD
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6363 FRANCE AVE S STE 200
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2140
Mailing Address - Country:US
Mailing Address - Phone:952-230-9100
Mailing Address - Fax:952-922-2525
Practice Address - Street 1:6363 FRANCE AVE S STE 200
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2140
Practice Address - Country:US
Practice Address - Phone:952-230-9100
Practice Address - Fax:952-922-2525
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2020-09-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN524512084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry