Provider Demographics
NPI:1407126915
Name:GRACZ, KENNETH CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:CHARLES
Last Name:GRACZ
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 1:1945 EASTCHESTER DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-0908
Mailing Address - Country:US
Mailing Address - Phone:336-887-1125
Mailing Address - Fax:
Practice Address - Street 1:1945 EASTCHESTER DR UNIT A
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-0908
Practice Address - Country:US
Practice Address - Phone:336-887-1125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-01
Last Update Date:2012-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC68566208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery