Provider Demographics
NPI:1831350776
Name:GRAHAM, DANIELLE LUEA (DO)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:LUEA
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:DANIELLE
Other - Middle Name:FAYE
Other - Last Name:LUEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5705 BLOOMFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-3191
Mailing Address - Country:US
Mailing Address - Phone:248-249-7355
Mailing Address - Fax:
Practice Address - Street 1:4677 TOWNE CENTRE RD
Practice Address - Street 2:SUITE 302
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2846
Practice Address - Country:US
Practice Address - Phone:989-793-7220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017686207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine