MEDICARE: NADINE K. JOHNSON-GIANNOPOULOS M.D.

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	207RH0003X	Hematology & Oncology Physician	R8968	MO
2	207RH0003X	Hematology & Oncology Physician	04-17256	KS

General Provider Information

NPI Number	:	1477524163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADINE K. JOHNSON-GIANNOPOULOS M.D.

Provider Business Mailing Address
First Line	:	818 CLERMONT ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75223-1214
Country	:	US
Telephone Number	:	913-909-8889
Fax Number	:

Provider Business Practice Location Address
First Line	:	818 CLERMONT ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75223-1214
Country	:	US
Telephone Number	:	913-909-8889
Fax Number	:

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	03/15/2016

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