Provider Demographics
NPI:1891782736
Name:GRAHAM, JAMES EWELL JR (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:EWELL
Last Name:GRAHAM
Suffix:JR
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 1:302 KENSINGTON AVE
Mailing Address - Street 2:GENESYS HURLEY CANCER INSTITUTE
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-2044
Mailing Address - Country:US
Mailing Address - Phone:810-762-8050
Mailing Address - Fax:810-762-8040
Practice Address - Street 1:302 KENSINGTON AVE
Practice Address - Street 2:GENESYS HURLEY CANCER INSTITUTE
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-2044
Practice Address - Country:US
Practice Address - Phone:810-762-8050
Practice Address - Fax:810-762-8040
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJG055377207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3063848Medicaid
1602532801OtherBCBS
MI3063848Medicaid
D14679Medicare UPIN