Provider Demographics
NPI:1841255460
Name:MCGRAW, JODI PETERSON (MD)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:PETERSON
Last Name:MCGRAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:L
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:103 QUAIL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BARNEVELD
Mailing Address - State:WI
Mailing Address - Zip Code:53507-9408
Mailing Address - Country:US
Mailing Address - Phone:608-924-3939
Mailing Address - Fax:608-924-3999
Practice Address - Street 1:103 QUAIL RIDGE DR
Practice Address - Street 2:
Practice Address - City:BARNEVELD
Practice Address - State:WI
Practice Address - Zip Code:53507-9408
Practice Address - Country:US
Practice Address - Phone:608-924-3939
Practice Address - Fax:608-924-3999
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39202-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI60201OtherDEAN HEALTH INSURANCE
WI34480200Medicaid
WI1044997OtherPHYSICIANS PLUS
WI60201OtherDEAN HEALTH INSURANCE
WI000174252Medicare PIN
WIP00740249Medicare PIN
WI1044997OtherPHYSICIANS PLUS