Provider Demographics
NPI:1861644940
Name:DEGIOVANNI, GINA MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:MARIE
Last Name:DEGIOVANNI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 WATER ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU SAC
Mailing Address - State:WI
Mailing Address - Zip Code:53578-1332
Mailing Address - Country:US
Mailing Address - Phone:773-330-6502
Mailing Address - Fax:
Practice Address - Street 1:295 WATER ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU SAC
Practice Address - State:WI
Practice Address - Zip Code:53578-1332
Practice Address - Country:US
Practice Address - Phone:773-330-6502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI55307-020207Q00000X
IL036130595207Q00000X
ILAU3890402/C6623208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery