Individual
DR. LISA S GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5007 MATTERHORN DRIVE, DULUTH, MN 55811-3812
(218) 720-3553
(218) 786-9375
Mailing address
5007 MATTERHORN DRIVE, DULUTH, MN 55811-3812
(218) 720-3553
(218) 786-9375
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
42312
WI
207W00000X
Ophthalmology Physician
Primary
42312-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33333100
—
WI
05
—
837658100
—
MN
Enumeration date
01/30/2006
Last updated
08/23/2010
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