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General NPI Number Information
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NPI Number | 1326340886
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Entity Type | Organization
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Legal Business Name | J MICHAEL GIANNINI PSC
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Dates
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Enumeration Date | 12/03/2010
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Last Update Date | 12/03/2010
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Provider Practice Location Address
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Address Line | 2138 BROADWAY ST
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City | PADUCAH
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State | KY
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Zip | 42001-7110
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Country | US
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Telephone | 270-444-7248
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Fax | 270-444-6014
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Provider Business Mailing Address
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Address Line | 2138 BROADWAY ST
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City | PADUCAH
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State | KY
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Zip | 42001-7110
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Country | US
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Telephone | 270-444-7248
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Fax | 270-444-6014
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. J MICHAEL GIANNINI
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Credential | MD
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Telephone | 270-444-7248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 036091667
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 17473
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License Number State | KY
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