Healthcare Provider Details

I. General information

NPI: 1720183221
Provider Name (Legal Business Name): TONY GIANOULIS MD, MHA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 E KIMBALLS LN
DRAPER UT
84020-5020
US

IV. Provider business mailing address

294 N FEDERAL HEIGHTS CIR
SALT LAKE CITY UT
84103-4490
US

V. Phone/Fax

Practice location:
  • Phone: 801-641-7396
  • Fax:
Mailing address:
  • Phone: 801-641-7396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number186030-1205
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier190382600
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerUS DEPT OF LABOR
# 2
Identifier870525882GI1
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerEDUCATORS MUTUAL
# 3
Identifier870525882
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerWPS WEST REGION
# 4
Identifier52945
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerHEALTHY U
# 5
IdentifierPR00526
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerMOLINA
# 6
IdentifierQM0000076595
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerALTIUS
# 7
Identifier212703
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerDESERET MUTUAL
# 8
Identifier32665
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerPEHP

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: