Provider Demographics
NPI:1912929019
Name:GIANGIACOMO, ANNETTE LYNN (MD)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:LYNN
Last Name:GIANGIACOMO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1087 W MASON ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-1859
Mailing Address - Country:US
Mailing Address - Phone:920-499-3102
Mailing Address - Fax:920-499-9636
Practice Address - Street 1:1087 W MASON ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-1859
Practice Address - Country:US
Practice Address - Phone:920-499-3102
Practice Address - Fax:920-499-9636
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91112207W00000X
NC2006-01410207W00000X
WI44891207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A911120OtherMEDICAL PPIN #
CAWA91112AMedicare ID - Type UnspecifiedPPIN #
CAI31590Medicare UPIN