Provider Demographics
NPI:1649239542
Name:GIOVANNONE, RICCARDO (DO)
Entity Type:Individual
Prefix:DR
First Name:RICCARDO
Middle Name:
Last Name:GIOVANNONE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:693 STOCKFORD DR
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1460
Mailing Address - Country:US
Mailing Address - Phone:517-265-0229
Mailing Address - Fax:517-265-0829
Practice Address - Street 1:693 STOCKFORD DR
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1460
Practice Address - Country:US
Practice Address - Phone:517-264-0756
Practice Address - Fax:517-263-9796
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011992207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI424074911Medicaid
MI383542312OtherTAX ID #
MI2054600215OtherBCBS
MI2054600215OtherBCBS