Provider Demographics
NPI:1619956026
Name:GRAZIANO, ANTHONY F (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:F
Last Name:GRAZIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38209 GENESEE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066
Mailing Address - Country:US
Mailing Address - Phone:262-965-2344
Mailing Address - Fax:414-219-4941
Practice Address - Street 1:945 NORTH 12TH STREET
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53201
Practice Address - Country:US
Practice Address - Phone:414-219-7880
Practice Address - Fax:414-219-4941
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33802-020207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31965500Medicaid
WID91322Medicare UPIN
WI0014Medicare ID - Type Unspecified