Provider Demographics
NPI:1194936344
Name:GRAVES, CHRISTOPHER L (MD)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:L
Last Name:GRAVES
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 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10400 HALIGUS RD FL 2
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-9553
Practice Address - Country:US
Practice Address - Phone:224-654-0000
Practice Address - Fax:224-654-0000
Is Sole Proprietor?:No
Enumeration Date:2007-05-26
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD198090207L00000X
MO2024031394207L00000X
IN01088824A207L00000X
IL036158785207L00000X
NY261409207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300069173Medicaid