Provider Demographics
NPI:1528408960
Name:GIOVANNETTI, ANDRES ELEAZAR (MD)
Entity Type:Individual
Prefix:MR
First Name:ANDRES
Middle Name:ELEAZAR
Last Name:GIOVANNETTI
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 1:3000 N HALSTED ST STE 703
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5196
Mailing Address - Country:US
Mailing Address - Phone:773-327-6800
Mailing Address - Fax:773-327-6877
Practice Address - Street 1:3000 N HALSTED ST STE 703
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657
Practice Address - Country:US
Practice Address - Phone:773-327-6800
Practice Address - Fax:773-327-6877
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-30
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036145582208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36145582Medicaid