Provider Demographics
NPI:1124044581
Name:GIANNI, KEITH B (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:B
Last Name:GIANNI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1222 WELL ST
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-2835
Mailing Address - Country:US
Mailing Address - Phone:907-452-6137
Mailing Address - Fax:907-452-6139
Practice Address - Street 1:1222 WELL ST
Practice Address - Street 2:SUITE ONE
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-2835
Practice Address - Country:US
Practice Address - Phone:907-452-6137
Practice Address - Fax:907-452-6139
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
AKAK0979207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKC97091Medicare UPIN