Healthcare Provider Details

I. General information

NPI: 1457787475
Provider Name (Legal Business Name): GIOVANNI D. GIANNOTTI MD, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 W DIVISION ST SUITE 335
CHICAGO IL
60622-2717
US

IV. Provider business mailing address

2222 W DIVISION ST SUITE 335
CHICAGO IL
60622-2717
US

V. Phone/Fax

Practice location:
  • Phone: 773-541-8100
  • Fax: 773-541-8109
Mailing address:
  • Phone: 773-541-8100
  • Fax: 773-541-8109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number036098872
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number036098872
License Number StateIL

VIII. Authorized Official

Name: GIOVANNI D GIANNOTTI
Title or Position: OWNER
Credential: M.D.
Phone: 847-456-7295