Active NPI
Stephen E Graham, D.V.M.
- Veterinarian
- Union Grove, WI
National Provider Identifier
1659612711
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Veterinarian
- License
- 090009537
- Practice address
- 17622 Burlington Rd
Union Grove, WI 53182-9413 - Phone
- (262) 859-2560
- Fax
- (262) 859-0459
- NPI assigned
- Mar 13, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Veterinarian | 174M00000X | 090009537 | IL | Primary |
| Veterinarian | 174M00000X | 6120-50 | WI |
Addresses
Primary practice location
17622 Burlington Rd
Union Grove, WI 53182-9413
Mailing address
17622 Burlington Rd
Union Grove, WI 53182-9413
Phone (262) 859-2560
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 090009537 | IL | MD | Veterinarian |
| 6120-50 | WI | MD | Veterinarian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1363132800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363132800000",
"number": "1659612711",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17622 BURLINGTON RD",
"city": "UNION GROVE",
"state": "WI",
"postal_code": "531829413",
"telephone_number": "262-859-2560",
"fax_number": "262-859-0459"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17622 BURLINGTON RD",
"city": "UNION GROVE",
"state": "WI",
"postal_code": "531829413",
"telephone_number": "262-859-2560",
"fax_number": "262-859-0459"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAHAM",
"first_name": "STEPHEN",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "D.V.M.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-03-13",
"last_updated": "2013-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "174M00000X",
"taxonomy_group": "",
"desc": "Veterinarian",
"state": "IL",
"license": "090009537",
"primary": true
},
{
"code": "174M00000X",
"taxonomy_group": "",
"desc": "Veterinarian",
"state": "WI",
"license": "6120-50",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Union Grove, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.