Provider Demographics
NPI:1639533888
Name:AGRANAT, JOSHUA (MD)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:AGRANAT
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 1:4131 W LOOMIS RD STE 240
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53221-2072
Mailing Address - Country:US
Mailing Address - Phone:262-510-0300
Mailing Address - Fax:262-510-0500
Practice Address - Street 1:4131 W LOOMIS RD STE 240
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53221-2072
Practice Address - Country:US
Practice Address - Phone:262-510-0300
Practice Address - Fax:262-510-0500
Is Sole Proprietor?:No
Enumeration Date:2016-04-13
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD207308207W00000X, 207WX0107X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI8423020OtherSTATE LICENSE
MA282819OtherSTATE LICENSE
ORMD207308OtherSTATE LICENSE
WI100284824Medicaid