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General NPI Number Information
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NPI Number | 1306189204
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Entity Type | Individual
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Provider Name | JOSEPH GIANCARLO D.O.
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Gender | Male
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Dates
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Enumeration Date | 03/29/2013
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Last Update Date | 06/23/2016
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Provider Practice Location Address
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Address Line | 114 BARNEY DR
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City | JOLIET
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State | IL
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Zip | 60435-6404
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Country | US
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Telephone | 708-743-7136
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Fax |
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Provider Business Mailing Address
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Address Line | 18539 ZURICH LN
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City | TINLEY PARK
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State | IL
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Zip | 60477-4406
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Country | US
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Telephone | 708-743-7136
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036.139846
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License Number State | IL
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