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General NPI Number Information
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NPI Number | 1902398514
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Entity Type | Individual
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Provider Name | RICHARD F GIANNOTTI JR.
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Gender | Male
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Dates
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Enumeration Date | 05/31/2018
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Last Update Date | 03/01/2023
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Provider Practice Location Address
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Address Line | 4401 CAMPUS RIDGE DR
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City | MIDLAND
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State | MI
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Zip | 48640-6112
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Country | US
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Telephone | 989-837-9350
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 MEDICAL CAMPUS DR
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-7823
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Country | US
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Telephone | 231-935-8000
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Fax | 231-935-8099
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101023989
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 5101025748
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License Number State | MI
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