Provider Demographics
NPI:1780787945
Name:GRAEFEN, THOMAS ALAN (DPM)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALAN
Last Name:GRAEFEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3326 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1108
Mailing Address - Country:US
Mailing Address - Phone:773-528-5466
Mailing Address - Fax:773-244-2265
Practice Address - Street 1:3326 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1108
Practice Address - Country:US
Practice Address - Phone:773-528-5466
Practice Address - Fax:773-244-2265
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T38981Medicare UPIN
IL778670Medicare ID - Type Unspecified