Individual
BRETT HARRISON GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
1002 WISHARD BLVD, INDIANAPOLIS, IN 46202-4163
(317) 944-3966
(317) 968-1354
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207SG0201X
Clinical Genetics (M.D.) Physician
Primary
01078449A
IN
207SG0201X
Clinical Genetics (M.D.) Physician
L6918
TX
207SG0202X
Clinical Biochemical Genetics Physician
01078449A
IN
208000000X
Pediatrics Physician
L6918
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001105334
ANTHEM PTAN
IN
05
—
162909901
—
TX
05
—
300004246
—
IN
Enumeration date
10/17/2006
Last updated
02/21/2025
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