Individual provider Active NPI

Imani Graham, DPM

  • Student in an Organized Health Care Education/Training Program
  • Indianapolis, IN
National Provider Identifier
1205770690
Registry record updated Jul 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
License
41000520A Issued in IN
Practice address
10122 E 10TH St Ste 230
Indianapolis, IN 46229-2664
Phone
(317) 355-7356
Fax
(317) 806-1175
NPI assigned
Apr 16, 2026
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 41000520A IN Primary

Addresses

Primary practice location

10122 E 10TH St Ste 230
Indianapolis, IN 46229-2664

Mailing address

10122 E 10TH St Ste 230
Indianapolis, IN 46229-2664

Other practice location 1

9220 Robey Glen Dr
Indianapolis, IN 46234-8627
Phone (317) 246-8220

Other identifiers 1

IdentifierTypeStateIssuer
300133660MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260613000347 IN Order and Referring Only - PodiatryPractitioner - Podiatry 1355813056

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1776297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784764800000",
    "number": "1205770690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10122 E 10TH ST STE 230",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462292664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10122 E 10TH ST STE 230",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462292664",
            "telephone_number": "317-355-7356",
            "fax_number": "317-806-1175"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9220 Robey Glen Dr",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462348627",
            "country_code": "US",
            "telephone_number": "317-246-8220",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "IMANI",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-04-16",
        "last_updated": "2026-07-23",
        "certification_date": "2026-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IN",
            "license": "41000520A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300133660",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.