Healthcare Provider Details

I. General information

NPI: 1619956026
Provider Name (Legal Business Name): ANTHONY F GRAZIANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 NORTH 12TH STREET
MILWAUKEE WI
53201
US

IV. Provider business mailing address

38209 GENESEE LAKE RD
OCONOMOWOC WI
53066
US

V. Phone/Fax

Practice location:
  • Phone: 414-219-7880
  • Fax: 414-219-4941
Mailing address:
  • Phone: 262-965-2344
  • Fax: 414-219-4941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number33802-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: