Provider Demographics
NPI:1912050287
Name:MICHAEL J GRAFE DO LTD
Entity type:Organization
Organization Name:MICHAEL J GRAFE DO LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRAFE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:575-746-3616
Mailing Address - Street 1:301 S ROSELAWN AVE
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210-2462
Mailing Address - Country:US
Mailing Address - Phone:575-746-3615
Mailing Address - Fax:575-748-2544
Practice Address - Street 1:301 S ROSELAWN AVE
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-2462
Practice Address - Country:US
Practice Address - Phone:575-746-3615
Practice Address - Fax:575-748-2544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-718-81207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM700521092Medicare PIN