Provider Demographics
NPI:1154362150
Name:GRAHAM, MICHAEL FRED (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FRED
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 SUNSET DR
Mailing Address - Street 2:SUITE 501
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4828
Mailing Address - Country:US
Mailing Address - Phone:305-667-7878
Mailing Address - Fax:305-667-7459
Practice Address - Street 1:6200 SUNSET DR
Practice Address - Street 2:SUITE 501
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4828
Practice Address - Country:US
Practice Address - Phone:305-667-7878
Practice Address - Fax:305-667-7459
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME33568208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD63343Medicare UPIN
FL95130Medicare ID - Type Unspecified