Active NPI
Michael A Graham
- Anatomic Pathology & Clinical Pathology Physician
- St Louis, MO
National Provider Identifier
1760591325
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- R7841
- Practice address
- 1402 S Grand
St Louis, MO 63110 - Phone
- (314) 577-8693
- Fax
- (314) 268-5478
- NPI assigned
- Aug 29, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | R7841 | MO | Primary |
Addresses
Primary practice location
1402 S Grand
St Louis, MO 63110
Mailing address
3691 Rutger Ave
Provider Enrollment
St Louis, MO 63110
Phone (314) 977-4440
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R7841 | MO | MD | Anatomic Pathology & Clinical Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1199836800000",
"number": "1760591325",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3691 RUTGER AVE",
"address_2": "PROVIDER ENROLLMENT",
"city": "ST LOUIS",
"state": "MO",
"postal_code": "63110",
"telephone_number": "314-977-4440"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1402 S GRAND",
"city": "ST LOUIS",
"state": "MO",
"postal_code": "63110",
"telephone_number": "314-577-8693",
"fax_number": "314-268-5478"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAHAM",
"first_name": "MICHAEL",
"middle_name": "A",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-29",
"last_updated": "2008-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "MO",
"license": "R7841",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.