Provider Demographics
NPI:1134108178
Name:GIANNINI, JAMES MICHAEL (M D)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:GIANNINI
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2138 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-7110
Mailing Address - Country:US
Mailing Address - Phone:270-444-7248
Mailing Address - Fax:270-444-6014
Practice Address - Street 1:2138 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7110
Practice Address - Country:US
Practice Address - Phone:270-444-7248
Practice Address - Fax:270-444-6014
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY17473207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000047676OtherBLUE SHIELD
KY64174733Medicaid
KYD08081Medicare UPIN
KY1126201Medicare ID - Type Unspecified
KY64174733Medicaid