Provider Demographics
NPI:1063472470
Name:GIANNAKIS, JOHN GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:GEORGE
Last Name:GIANNAKIS
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 1:135 VISION PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3001
Mailing Address - Country:US
Mailing Address - Phone:281-404-3000
Mailing Address - Fax:936-273-6911
Practice Address - Street 1:135 VISION PARK BLVD
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3001
Practice Address - Country:US
Practice Address - Phone:281-404-3000
Practice Address - Fax:936-273-6911
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1883208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140070724Medicaid
TX340014668Medicare PIN
TX140070724Medicaid
TX85T512Medicare PIN