Provider Demographics
NPI:1649247412
Name:CODY, GRAHAM A (MD)
Entity type:Individual
Prefix:
First Name:GRAHAM
Middle Name:A
Last Name:CODY
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 1:700 REGENT ST
Mailing Address - Street 2:GHC
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-2634
Mailing Address - Country:US
Mailing Address - Phone:608-441-3290
Mailing Address - Fax:608-441-3291
Practice Address - Street 1:700 REGENT ST
Practice Address - Street 2:GHC
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-2634
Practice Address - Country:US
Practice Address - Phone:608-441-3290
Practice Address - Fax:608-441-3291
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI286252084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30855100Medicaid
WIBC 0987771OtherDEA NUMBER
WIBC 0987771OtherDEA NUMBER
WI000184943Medicare PIN