Provider Demographics
NPI:1962510024
Name:GIACOMINI, PAOLO C (MD)
Entity Type:Individual
Prefix:DR
First Name:PAOLO
Middle Name:C
Last Name:GIACOMINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 ASH STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992
Mailing Address - Country:US
Mailing Address - Phone:260-563-8875
Mailing Address - Fax:260-569-9803
Practice Address - Street 1:400 ASH STREET
Practice Address - Street 2:SUITE C
Practice Address - City:WABASH
Practice Address - State:IN
Practice Address - Zip Code:46992
Practice Address - Country:US
Practice Address - Phone:260-563-8875
Practice Address - Fax:260-569-9803
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038356208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
C64133Medicare UPIN
IN862060Medicare ID - Type Unspecified