Individual
TONNIEO GRAVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
16866 MENDOTA ST, DETROIT, MI 48221-2829
(313) 999-9999
Mailing address
16866 MENDOTA ST, DETROIT, MI 48221-2829
(313) 999-9999
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G612799397633
LICENSE
MI
Enumeration date
12/05/2013
Last updated
12/05/2013
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