Provider Demographics
NPI:1043392905
Name:GRANEY, NEIGATHA ELEASE (MD)
Entity Type:Individual
Prefix:
First Name:NEIGATHA
Middle Name:ELEASE
Last Name:GRANEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6832 CHADWICK DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-1634
Mailing Address - Country:US
Mailing Address - Phone:734-459-1219
Mailing Address - Fax:734-459-1219
Practice Address - Street 1:8550 W GRAND RIVER AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-4352
Practice Address - Country:US
Practice Address - Phone:810-220-3700
Practice Address - Fax:810-220-1321
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301049607208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2981150Medicaid
MIA78756Medicare UPIN