Provider Demographics
NPI:1841369642
Name:GIANNELLI, ANTONIO P (PAC)
Entity type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:P
Last Name:GIANNELLI
Suffix:
Gender:M
Credentials:PAC
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Mailing Address - Street 1:4052 LEGACY PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4285
Mailing Address - Country:US
Mailing Address - Phone:517-272-9700
Mailing Address - Fax:
Practice Address - Street 1:4052 LEGACY PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4285
Practice Address - Country:US
Practice Address - Phone:517-272-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI1821562363A00000X
MI5601001053363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1821562OtherLICENSE
MI1750472734OtherGROUP NPI NUMBER
MITI035364OtherSUPERVISOR IGNACZAK