Individual
DR. TERRENCE M GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM,FACFAS
Contact information
Practice address
2 MEMORIAL DR STE 305, DECATUR, IL 62526-3999
(217) 876-4830
(217) 876-8385
Mailing address
102 W KENWOOD AVE, SUITE 150, DECATUR, IL 62526-4368
(217) 875-3668
(217) 875-4277
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
016003032
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0060215009
BCBS
IL
05
—
016003032
—
IL
01
—
480008850
RR MEDICARE
IL
Enumeration date
11/16/2005
Last updated
02/28/2018
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