Provider Demographics
NPI:1306901400
Name:GIACCHINO, JOSEPH L JR (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:L
Last Name:GIACCHINO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1252 WINSTON PLAZA
Mailing Address - Street 2:
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160
Mailing Address - Country:US
Mailing Address - Phone:708-343-2500
Mailing Address - Fax:708-343-9545
Practice Address - Street 1:1252 WINSTON PLAZA
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160
Practice Address - Country:US
Practice Address - Phone:708-343-2500
Practice Address - Fax:708-343-9545
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036050366207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL16172816OtherBLUE CROSS BLUE SHIELD
IL036050366Medicaid
IL738410OtherMEDICARE
C45876Medicare UPIN
IL036050366Medicaid