Provider Demographics
NPI:1154982502
Name:GRACA, MATEUSZ J (MD)
Entity type:Individual
Prefix:
First Name:MATEUSZ
Middle Name:J
Last Name:GRACA
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 1:6000 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-2226
Mailing Address - Country:US
Mailing Address - Phone:954-771-2551
Mailing Address - Fax:954-492-3830
Practice Address - Street 1:6000 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-2226
Practice Address - Country:US
Practice Address - Phone:954-771-2551
Practice Address - Fax:954-492-3830
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME161251207L00000X, 207LP2900X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine