Individual
DR. COREY FRENCH GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1000 PROVIDENT DR, SUITE C, WARSAW, IN 46580-3255
(574) 267-8728
(574) 269-3470
Mailing address
7916 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 434-6071
(260) 434-6389
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01074316A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201246970
—
IN
01
—
262490014
MEDICARE PTAN
IN
Enumeration date
06/30/2008
Last updated
12/15/2021
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