Individual
MICHAEL A GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1402 S GRAND, ST LOUIS, MO 63110
(314) 577-8693
(314) 268-5478
Mailing address
3691 RUTGER AVE, PROVIDER ENROLLMENT, ST LOUIS, MO 63110
(314) 977-4440
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
R7841
MO
Other
Enumeration date
08/29/2006
Last updated
01/09/2008
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