Provider Demographics
NPI:1548859176
Name:GIANNINI, JOSEPH GIANCARLO
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:GIANCARLO
Last Name:GIANNINI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3978 S LAKE PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-2555
Mailing Address - Country:US
Mailing Address - Phone:773-405-3072
Mailing Address - Fax:
Practice Address - Street 1:3978 S LAKE PARK AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-2555
Practice Address - Country:US
Practice Address - Phone:773-405-3072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver