Provider Demographics
NPI:1720183221
Name:GIANOULIS, TONY (MD, MHA)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:GIANOULIS
Suffix:
Gender:M
Credentials:MD, MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 N FEDERAL HEIGHTS CIR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-4490
Mailing Address - Country:US
Mailing Address - Phone:801-641-7396
Mailing Address - Fax:
Practice Address - Street 1:96 E KIMBALLS LN
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-5020
Practice Address - Country:US
Practice Address - Phone:801-641-7396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT186030-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT190382600OtherUS DEPT OF LABOR
UT870525882GI1OtherEDUCATORS MUTUAL
UT870525882OtherWPS WEST REGION
UT52945OtherHEALTHY U
UTPR00526OtherMOLINA
UTQM0000076595OtherALTIUS
UT212703OtherDESERET MUTUAL
UT32665OtherPEHP