Healthcare Provider Details

I. General information

NPI: 1649239542
Provider Name (Legal Business Name): RICCARDO GIOVANNONE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

693 STOCKFORD DR
ADRIAN MI
49221-1460
US

IV. Provider business mailing address

693 STOCKFORD DR
ADRIAN MI
49221-1460
US

V. Phone/Fax

Practice location:
  • Phone: 517-264-0756
  • Fax: 517-263-9796
Mailing address:
  • Phone: 517-265-0229
  • Fax: 517-265-0829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5101011992
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: