Provider Demographics
NPI:1124083514
Name:RONDO-HILLMAN, GIAVONNE D (MD)
Entity type:Individual
Prefix:
First Name:GIAVONNE
Middle Name:D
Last Name:RONDO-HILLMAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:GIAVONNE
Other - Middle Name:D
Other - Last Name:RONDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:305-500-2000
Mailing Address - Fax:
Practice Address - Street 1:1020 VETERANS PKWY STE 700
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-2390
Practice Address - Country:US
Practice Address - Phone:812-668-8144
Practice Address - Fax:877-772-5243
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056457A207R00000X
KY39559207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
017039OtherSIHO / NCMA
KY000023034COtherHUMANA FOR NCMA
1200861OtherCHA / NCMA
KY50006203OtherPASSPORT FOR NCMA
KY7100019410Medicaid
IN2004123330Medicaid
IN110244199OtherRAILROAD MEDICARE
89821218-001OtherCIGNA / NCMA
KY000000243727OtherANTHEM FOR NCMA
KY2447471000OtherPASS ADVANTAGE FOR NCMA
KY7100019410Medicaid
H74623Medicare UPIN
IN2004123330Medicaid