Individual
TRAVIS AUSTIN GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1130 WEST MICHIGAN STREET, FH204, INDIANAPOLIS, IN 46202
(317) 274-0076
Mailing address
1130 WEST MICHIGAN STREET, FH204, INDIANAPOLIS, IN 46202
(317) 274-0076
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
11017629A
IN
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
05/12/2014
Last updated
06/01/2015
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