Provider Demographics
NPI:1518069327
Name:DIGIANNANTONIO, GIOVANNI M (MD)
Entity Type:Individual
Prefix:DR
First Name:GIOVANNI
Middle Name:M
Last Name:DIGIANNANTONIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3495 S CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48519-1455
Mailing Address - Country:US
Mailing Address - Phone:810-424-2007
Mailing Address - Fax:810-743-1099
Practice Address - Street 1:4075 S CENTER RD
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48519-1453
Practice Address - Country:US
Practice Address - Phone:810-743-4120
Practice Address - Fax:810-743-0583
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301039053207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3236008Medicaid
MIB47020Medicare UPIN
MI3236008Medicaid