Healthcare Provider Details

I. General information

NPI: 1023001492
Provider Name (Legal Business Name): LOUIS S. GIANNONE D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 COMMERCIAL CT UNIT G
VENICE FL
34292-1650
US

IV. Provider business mailing address

411 COMMERCIAL CT STE G
VENICE FL
34292-1650
US

V. Phone/Fax

Practice location:
  • Phone: 941-412-3000
  • Fax: 941-966-6721
Mailing address:
  • Phone: 941-412-3000
  • Fax: 941-966-6721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO3077
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO3077
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: