Provider Demographics
NPI:1619989688
Name:GIANNOTTI, GIOVANNI DAVID (MD)
Entity Type:Individual
Prefix:
First Name:GIOVANNI
Middle Name:DAVID
Last Name:GIANNOTTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GIOVANNI
Other - Middle Name:DAVID
Other - Last Name:GIANNOTTI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2222 W DIVISION ST
Mailing Address - Street 2:STE 335
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2995
Mailing Address - Country:US
Mailing Address - Phone:773-273-6810
Mailing Address - Fax:773-273-5532
Practice Address - Street 1:5140 N CALIFORNIA AVE
Practice Address - Street 2:SUITE 780
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3645
Practice Address - Country:US
Practice Address - Phone:773-273-6810
Practice Address - Fax:773-273-5532
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360988722086X0206X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001630046OtherBCBS OF IL GROUP NUMBER
IL036098872 3Medicaid
IL036098872 2Medicaid
IL036098872 3Medicaid
IL000229777Medicare PIN
ILH73355Medicare UPIN