Provider Demographics
NPI:1295940658
Name:MINONNE, GIOVANNI ANTONIO
Entity type:Individual
Prefix:MR
First Name:GIOVANNI
Middle Name:ANTONIO
Last Name:MINONNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 E WILLIAM ST APT 22H
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2427
Mailing Address - Country:US
Mailing Address - Phone:734-883-6262
Mailing Address - Fax:
Practice Address - Street 1:555 E WILLIAM ST APT 22H
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2427
Practice Address - Country:US
Practice Address - Phone:734-883-6262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012819103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist