Provider Demographics
NPI:1477524163
Name:JOHNSON-GIANNOPOULOS, NADINE K (MD)
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:K
Last Name:JOHNSON-GIANNOPOULOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NADINE
Other - Middle Name:K
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:818 CLERMONT ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75223-1214
Mailing Address - Country:US
Mailing Address - Phone:913-909-8889
Mailing Address - Fax:
Practice Address - Street 1:818 CLERMONT ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75223-1214
Practice Address - Country:US
Practice Address - Phone:913-909-8889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8968207RH0003X
KS04-17256207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSE56294Medicare UPIN
KSK40000070Medicare PIN
KSP00953206Medicare PIN
KSE56294Medicare UPIN
MO1477524163Medicaid