Provider Demographics
NPI:1447416821
Name:INFUSINO, GIOVANNI ANNUNZIATO (MD)
Entity Type:Individual
Prefix:DR
First Name:GIOVANNI
Middle Name:ANNUNZIATO
Last Name:INFUSINO
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:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:1205 S MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-3677
Practice Address - Country:US
Practice Address - Phone:219-769-8340
Practice Address - Fax:219-769-8341
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01068177A207RP1001X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201000910Medicaid
IN201000910Medicaid