Healthcare Provider Details

I. General information

NPI: 1619989688
Provider Name (Legal Business Name): GIOVANNI DAVID GIANNOTTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GIOVANNI DAVID GIANNOTTI MD

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5140 N CALIFORNIA AVE SUITE 780
CHICAGO IL
60625-3645
US

IV. Provider business mailing address

2222 W DIVISION ST STE 335
CHICAGO IL
60622-2995
US

V. Phone/Fax

Practice location:
  • Phone: 773-273-6810
  • Fax: 773-273-5532
Mailing address:
  • Phone: 773-273-6810
  • Fax: 773-273-5532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036098872
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number036098872
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: