Provider Demographics
NPI:1831341536
Name:GRAHAM FAMILY MEDICINE INC
Entity type:Organization
Organization Name:GRAHAM FAMILY MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-998-9200
Mailing Address - Street 1:4501 W DEYOUNG ST
Mailing Address - Street 2:SUITE 107B
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-6360
Mailing Address - Country:US
Mailing Address - Phone:618-998-9200
Mailing Address - Fax:618-998-9700
Practice Address - Street 1:4501 W DEYOUNG ST
Practice Address - Street 2:SUITE 107B
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-6360
Practice Address - Country:US
Practice Address - Phone:618-998-9200
Practice Address - Fax:618-998-9700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty