Provider Demographics
NPI:1336129139
Name:GIACALONE, MICHAEL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:GIACALONE
Suffix:JR
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 1:225 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48502-1641
Mailing Address - Country:US
Mailing Address - Phone:810-406-4246
Mailing Address - Fax:810-424-6029
Practice Address - Street 1:G3375 S SAGINAW ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48529-1244
Practice Address - Country:US
Practice Address - Phone:810-743-6830
Practice Address - Fax:810-743-7086
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301032442207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMG032442OtherHEALTH PLUS AND BCBS
MI4832365Medicaid
MI0B56065021OtherMEDICARE ID
MI4832365Medicaid
MIMG032442OtherHEALTH PLUS AND BCBS