Provider Demographics
NPI:1215917851
Name:GRAVES, TAMMY O (DO)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:O
Last Name:GRAVES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:O
Other - Last Name:DREW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:SUITE E352
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-341-8986
Mailing Address - Fax:269-341-6236
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE E352
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-341-8986
Practice Address - Fax:269-341-6236
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010094452080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3041221Medicaid
MI3041221Medicaid
MIC97618144Medicare PIN