Provider Demographics
NPI:1770809873
Name:GRAHAN, BRIAN JOHN (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JOHN
Last Name:GRAHAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:BRIAN
Other - Middle Name:JOHN
Other - Last Name:HARAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:701 PARK AVE
Mailing Address - Street 2:G5
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1623
Mailing Address - Country:US
Mailing Address - Phone:612-873-4455
Mailing Address - Fax:
Practice Address - Street 1:701 PARK AVE
Practice Address - Street 2:G5
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1623
Practice Address - Country:US
Practice Address - Phone:612-873-4455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN56891207R00000X, 207RA0401X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics