Provider Demographics
NPI:1063792257
Name:GIANCARLO PIANO, MD LLC
Entity type:Organization
Organization Name:GIANCARLO PIANO, MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GIANCARLO
Authorized Official - Middle Name:
Authorized Official - Last Name:PIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-280-7958
Mailing Address - Street 1:25 E WASHINGTON ST
Mailing Address - Street 2:SUITE 1320
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-1708
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 E WASHINGTON ST
Practice Address - Street 2:SUITE 1320
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1708
Practice Address - Country:US
Practice Address - Phone:312-929-4265
Practice Address - Fax:312-929-4908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-19
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360667712086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK05978Medicare UPIN