Provider Demographics
NPI:1457787475
Name:GIOVANNI D. GIANNOTTI MD, S.C.
Entity Type:Organization
Organization Name:GIOVANNI D. GIANNOTTI MD, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GIOVANNI
Authorized Official - Middle Name:D
Authorized Official - Last Name:GIANNOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-456-7295
Mailing Address - Street 1:2222 W DIVISION ST
Mailing Address - Street 2:SUITE 335
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2717
Mailing Address - Country:US
Mailing Address - Phone:773-541-8100
Mailing Address - Fax:773-541-8109
Practice Address - Street 1:2222 W DIVISION ST
Practice Address - Street 2:SUITE 335
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2717
Practice Address - Country:US
Practice Address - Phone:773-541-8100
Practice Address - Fax:773-541-8109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360988722086S0102X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Multi-Specialty