MEDICARE: DR. RICHARD GIACOBETTI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	036-054090	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	070003464	OTHER	IL	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1407848666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD GIACOBETTI MD

Provider Business Mailing Address
First Line	:	3060 N ARLINGTON HEIGHTS RD
Second Line	:
City	:	ARLINGTON HTS
State	:	IL
Zip	:	60004-1530
Country	:	US
Telephone Number	:	847-394-1320
Fax Number	:	847-394-3674

Provider Business Practice Location Address
First Line	:	3060 N ARLINGTON HEIGHTS RD
Second Line	:
City	:	ARLINGTON HTS
State	:	IL
Zip	:	60004-1530
Country	:	US
Telephone Number	:	847-394-1320
Fax Number	:	847-394-3674

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	03/13/2008

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