Individual
MICHELLE L GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2055 KIMBALL AVE, SUITE 101, WATERLOO, IA 50702-5047
(319) 272-2112
(319) 272-2107
Mailing address
2055 KIMBALL AVE, SUITE 101, WATERLOO, IA 50702-5047
(319) 272-2112
(319) 272-2107
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34189
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
I245332
—
IA
Enumeration date
10/05/2005
Last updated
03/07/2023
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