Provider Demographics
NPI:1699757211
Name:GIANGRECO, ATILIO (MD)
Entity type:Individual
Prefix:
First Name:ATILIO
Middle Name:
Last Name:GIANGRECO
Suffix:
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:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-2329
Mailing Address - Country:US
Mailing Address - Phone:928-247-6516
Mailing Address - Fax:
Practice Address - Street 1:11611 S FOOTHILLS BLVD STE G
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85367-5845
Practice Address - Country:US
Practice Address - Phone:928-247-9616
Practice Address - Fax:928-276-4593
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26569174400000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ432112Medicaid
AZZ65594Medicare ID - Type Unspecified
AZA27554Medicare UPIN