Michael A Graham, | |
1402 S Grand, St Louis, MO 63110 | |
(314) 577-8693 | |
(314) 268-5478 |
Full Name | Michael A Graham |
---|---|
Gender | Male |
Speciality | Pathology - Anatomic Pathology & Clinical Pathology |
Location | 1402 S Grand, St Louis, Missouri |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1760591325 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207ZP0102X | Pathology - Anatomic Pathology & Clinical Pathology | R7841 (Missouri) | Primary |
Entity Name | Ssm Health Care Group |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1306589544 PECOS PAC ID: 0143608372 Enrollment ID: O20220531002655 |
Mailing Address | Practice Location Address |
---|---|
Michael A Graham, 3691 Rutger Ave, Provider Enrollment, St Louis, MO 63110 Ph: (314) 977-4440 | Michael A Graham, 1402 S Grand, St Louis, MO 63110 Ph: (314) 577-8693 |
Nancy J Phillips, MD Pathology Medicare: Accepting Medicare Assignments Practice Location: 1402 S Grand, St Louis, MO 63110 Phone: 314-577-8693 Fax: 314-268-5478 | |
William Henry Boyce, MD Pathology Medicare: Accepting Medicare Assignments Practice Location: 525 Couch Ave, St Louis, MO 63122 Phone: 314-721-1531 Fax: 314-822-6316 | |
Stephen E Godfrey, MD Pathology Medicare: Not Enrolled in Medicare Practice Location: 10010 Kennerly Road, St Louis, MO 63128 Phone: 314-525-4345 Fax: 314-525-4354 | |
Edward Stephen Bolesta, MD Pathology Medicare: Accepting Medicare Assignments Practice Location: 1402 S Grand, St Louis, MO 63104 Phone: 314-577-8000 | |
Richard G Hoover, MD Pathology Medicare: Not Enrolled in Medicare Practice Location: 1402 S Grand, St Louis, MO 63110 Phone: 314-577-8693 Fax: 314-268-5478 | |
Leonard E Grosso, MD PHD Pathology Medicare: Not Enrolled in Medicare Practice Location: 1402 S Grand, St Louis, MO 63110 Phone: 314-577-8693 Fax: 314-268-5478 |