Provider Demographics
NPI:1295279461
Name:GRANEY, COLIN T (DPM)
Entity type:Individual
Prefix:DR
First Name:COLIN
Middle Name:T
Last Name:GRANEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 W. WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703
Mailing Address - Country:US
Mailing Address - Phone:608-241-0848
Mailing Address - Fax:941-845-4963
Practice Address - Street 1:664 W. WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703
Practice Address - Country:US
Practice Address - Phone:608-241-0848
Practice Address - Fax:941-845-4963
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-07
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3957213ES0103X
WI1152-25213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery