Provider Demographics
NPI:1295355790
Name:CASTELLUCCI, GIOVANNI (MD, MS)
Entity type:Individual
Prefix:DR
First Name:GIOVANNI
Middle Name:
Last Name:CASTELLUCCI
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 W GRAND BLVD APT 209
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3169
Mailing Address - Country:US
Mailing Address - Phone:443-842-2247
Mailing Address - Fax:
Practice Address - Street 1:3901 BEAUBIEN BLVD.
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-1892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program